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C-Reactive Protein and White Blood Cell Count in Cardiogenic Shock
Jonas Dudda1,2, Tobias Schupp1,2, Jonas Rusnak1,2
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.
Insights
White blood cell (WBC) count on admission and C-reactive protein (CRP) levels during treatment predict 30-day mortality in cardiogenic shock (CS) patients. A CRP increase of 200% from day 1 to day 3 indicates higher mortality risk.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Biomarker Research
Background:
- Cardiogenic shock (CS) is a critical condition with high mortality.
- Prognostic data on inflammatory biomarkers in CS patients are limited.
- Early identification of high-risk CS patients is crucial for timely intervention.
Purpose of the Study:
- To investigate the prognostic impact of C-reactive protein (CRP) and white blood cell (WBC) counts on 30-day mortality in CS patients.
- To evaluate the predictive value of serial CRP measurements during intensive care unit (ICU) stay.
Main Methods:
- Retrospective analysis of 240 consecutive CS patients admitted to a cardiac ICU from 2019 to 2021.
- Laboratory measurements (CRP, WBC) collected on days 1, 2, 3, 4, and 8.
- Statistical analyses included C-statistics, Kaplan-Meier, and Cox regression to assess 30-day all-cause mortality.
Main Results:
- Overall 30-day mortality was 55%.
- WBC count on admission (AUC=0.605) and CRP levels on days 3-8 (AUC=0.623-0.754) predicted 30-day mortality.
- A CRP increase ≥200% from day 1 to day 3 significantly elevated mortality risk (HR=1.720).
Conclusions:
- Admission WBC count and serial CRP levels are valuable prognostic markers in CS.
- A significant increase in CRP during the early ICU course is associated with increased 30-day mortality.
- This study provides novel insights into the prognostic utility of inflammatory biomarkers in a broad CS patient cohort.
Abstract:
This study examines the prognostic impact of C-reactive protein (CRP) and white blood cell (WBC) counts in patients with cardiogenic shock (CS). Data regarding the prognostic impact of inflammatory biomarkers in CS are scarce. All consecutive patients with CS from 2019 to 2021 admitted to a cardiac intensive care unit (ICU) were included at one institution. Laboratory measurements were retrieved from the day of admission (i.e., day 1), as well as days 2, 3, 4, and 8. The primary endpoint was 30-day all-cause mortality. Statistical analyses included univariate t-tests, Spearman's correlations, C-statistics, Kaplan-Meier, and Cox regression analyses. From a total of 240 consecutive patients admitted with CS, 55% died within 30 days. CRP levels on days 3 to 8 were associated with reliable discrimination for 30-day all-cause mortality (area under the curve (AUC): 0.623-0.754), whereas CRP on day 1 was not (AUC = 0.514). In line, CRP > 100 mg/L on day 3 (56% vs. 37%; log-rank p = 0.023; HR = 1.702; 95% CI 1.060-2.735; p = 0.028) and especially a CRP increase of at least 200% from days 1 to day 3 (51% vs. 35%; log-rank p = 0.040; HR = 1.720; 95% CI 1.006-2.943; p = 0.048) were associated with an increased risk of all-cause mortality. Furthermore, WBC on day 1 discriminated 30-day all-cause mortality (AUC = 0.605; p = 0.005) with an increased risk of all-cause mortality in patients admitted with WBC > 10 × 106/mL (59% vs. 40%; log-rank p = 0.036; HR = 1.643; 95% CI 1.010-2.671; p = 0.045). In conclusion, WBC count on admission as well as CRP levels during the course of ICU treatment were associated with 30-day all-cause mortality. Specifically, an increase of CRP levels by at least 200% from day 1 to day 3 during the course of ICU treatment was associated with an increased risk of 30-day all-cause mortality. The present study is one of the first to describe the prognostic value of inflammatory biomarkers in consecutive all-comer CS patients treated at a cardiac ICU.
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