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Author Spotlight: Developing Innovative Therapeutic Strategies for Hemorrhagic Shock Research
Published on: March 22, 2024
Biomarker patterns in patients with cardiogenic shock versus septic shock
Elma J Peters1, Martin S Frydland2, Christian Hassager2
1Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Insights
Cardiogenic shock (CS) and septic shock (SS) share similar mortality rates, but distinct biomarkers predict outcomes in CS patients. Understanding these differences is crucial for targeted treatment strategies in critical care.
Area of Science:
- Cardiology
- Critical Care Medicine
- Biomarker Research
Background:
- Cardiogenic shock (CS) involves contractile failure often with systemic inflammation.
- Septic shock (SS) frequently presents with cardiac dysfunction.
- Current hemodynamic support strategies for CS and SS are often similar, despite differing pathophysiological profiles.
Purpose of the Study:
- To compare neurohormonal activation and cardiovascular stress biomarkers in patients with CS and SS.
- To determine if biomarker profiles differ between CS and SS.
- To assess the prognostic value of biomarkers in each shock type.
Main Methods:
- A prospective, multicenter cohort study matched 111 CS patients with SS patients.
- Clinical data and blood samples were collected within the first 1-3 days of ICU admission.
- Biomarker concentrations were analyzed to assess neurohormonal activation and cardiovascular stress.
Main Results:
- The study included 222 patients (mean age 61 years, 37% male).
- Thirty-day mortality rates were similar between CS (40.5%) and SS (43.1%).
- While SS patients had higher overall biomarker concentrations, only CS patients showed biomarker concentrations associated with mortality.
Conclusions:
- Septic shock and cardiogenic shock patients exhibit comparable baseline characteristics and mortality.
- Biomarker profiles differ between CS and SS, with prognostic value primarily observed in CS.
- These findings suggest a need for tailored biomarker assessment and potentially distinct therapeutic approaches for CS versus SS.
Background:
In cardiogenic shock (CS), contractile failure is often accompanied by a systemic inflammatory response syndrome. In contrast, many patients with septic shock (SS) develop cardiac dysfunction. A similar hemodynamic support strategy is often deployed in both syndromes but it is unclear whether this is justified based on profiles of biomarkers expressing neurohormonal activation and cardiovascular stress.
Methods:
In this prospective, multicenter cohort, 111 patients with acute myocardial infarction related CS were identified, and matched to patients with SS. Clinical parameters were collected and blood samples were obtained on day 1-3 of Intensive Care admission.
Results:
In this shock cohort comprising 222 patients, with a mean age of 61 (±13.5) years and of whom 161 (37 %) were male, we found that despite obvious clinical disparities on admission, mortality at 30-days did not differ (CS: 40.5 % vs. SS 43.1 %, p = 0.56). Overall, plasma concentrations of all biomarkers were higher in SS patients, with the largest difference on the first day. However, only in CS patients the biomarker concentrations were associated with mortality.
Conclusion:
In this prospective, multicenter cohort SS and CS patients showed similarities in baseline conditions and had similar mortality. However, several biomarkers only showed prognostic value in CS.
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