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An outlook on biomarkers in cardiogenic shock
Oriol Iborra-Egea1,2, Santi Montero1,2, Antoni Bayes-Genis1,2
1Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona.
Insights
Novel biomarkers are crucial for managing cardiogenic shock. The CS4P score shows promise in identifying patient risk, improving stratification beyond existing methods.
Area of Science:
- Biomarkers and diagnostics
- Cardiovascular medicine
- Critical care
Background:
- Cardiogenic shock has high mortality (~50%) and requires precise risk stratification.
- Existing biomarkers (BNP, troponins) have limited predictive power in cardiogenic shock.
- Novel biomarkers are needed for personalized therapy and improved patient management.
Purpose of the Study:
- To review emerging biomarkers for cardiogenic shock risk stratification.
- To highlight the potential of novel molecular techniques in identifying high-risk patients.
- To discuss the clinical utility of new biomarkers in personalizing cardiogenic shock treatment.
Main Methods:
- Review of recent literature on cardiogenic shock biomarkers.
- Analysis of novel biomarkers including DPP3, adrenomedullin, angiopoietin 2, and the CS4P score.
- Comparison of the predictive value of new biomarkers against established scores like CardShock.
Main Results:
- Established biomarkers show insufficient predictive value in cardiogenic shock.
- DPP3 demonstrates early prediction of refractory status and survival.
- The CS4P score, utilizing L-FABP, B2M, ALDOB, and SerpinG1, improved patient reclassification by 32% compared to CardShock.
- CS4P reflects multiorgan dysfunction and systemic inflammation, not just cardiac-specific markers.
Conclusions:
- Novel biomarkers offer improved risk stratification for cardiogenic shock patients.
- The CS4P score is a promising tool for clinical decision-making in cardiogenic shock.
- Prospective validation of the CS4P score in diverse patient populations, including those with assist devices, is warranted.
Purpose Of Review:
Cardiogenic shock is a severe complication with mortality rates of ∼50% that requires a rapid and complex management to aid and identify the highest and lowest risk patients. To that end, novel cardiogenic shock biomarkers are needed to improve risk stratification and to personalize therapy.
Recent Findings:
Established biomarkers such as BNP, NT-proBNP, ST2, and troponins provide insufficient predictive value in cardiogenic shock. More recent biomarkers, including DPP3, adrenomedullin, angiopoietin 2, and the CS4P score are gaining momentum. DPP3 showed early prediction of refractory status and survival in cardiogenic shock. The CS4P score is based on the levels of liver fatty acid-binding protein (L-FABP), beta-2-microglobulin (B2M), fructose-bisphosphate aldolase B (ALDOB), and SerpinG1 (IC1). These proteins are not cardiac-specific but reflect multiorgan dysfunction, systemic inflammation, and immune activation. The CS4P improved reclassification of 32% of patients compared with the CardShock risk score.
Summary:
A new wave of research focused on novel proteomic and molecular techniques, is providing new candidates that promise to aid clinical decision-making and patient stratification in cardiogenic shock. The CS4P score is emerging as the most robust, yet it requires prospective validation in cardiogenic shock patients managed with circulatory and ventricular assist devices.
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