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Published on: June 12, 2021
Validation of a biomarker-based mortality score for cardiogenic shock patients: Comparison with a clinical risk score
Elina Hynninen1, Heli Tolppanen1, Mercedes Rivas-Lasarte2
1Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Insights
The CLIP score accurately predicts 90-day mortality in patients with cardiogenic shock (CS) within 12 hours of admission. This biomarker-based score complements existing risk scores, aiding clinical decisions and trial design for acute heart failure.
Area of Science:
- Cardiology
- Critical Care Medicine
- Biomarker Discovery
Background:
- Cardiogenic shock (CS) is a severe form of acute heart failure with high mortality.
- Accurate risk prediction is essential for managing CS patients and designing clinical trials.
- Existing risk scores may require enhancement for improved prognostic accuracy.
Purpose of the Study:
- To validate the CLIP score (cystatin C, lactate, interleukin-6, NT-proBNP) for predicting 90-day mortality in acute coronary syndrome (ACS) related CS.
- To compare the predictive performance of the CLIP score against the established CardShock risk score.
- To assess the utility of the CLIP score in risk stratification and clinical decision-making.
Main Methods:
- Post hoc analysis of the prospective, observational European CardShock Study cohort (n=121).
- CLIP score calculated within 12 hours of hospital admission.
- Receiver-operating characteristic (ROC) curve analysis used to assess predictive accuracy (AUC) and compare scores.
Main Results:
- The CLIP score demonstrated strong predictive accuracy for 90-day mortality (AUC 0.84).
- CLIP score's predictive value was comparable to the CardShock risk score (AUC 0.77).
- A CLIP score cut-off of 0.28 effectively stratified patients into high (65% mortality) and low (16% mortality) risk groups.
- Incorporating the CLIP score improved risk stratification across all CardShock risk score categories.
Conclusions:
- The CLIP score accurately predicts 90-day mortality in CS patients when calculated early after admission.
- The CLIP score serves as a valuable complement to the CardShock risk score, enhancing prognostic assessment.
- This biomarker-based score holds potential for dynamic risk assessment, guiding clinical management and future trial design in CS.
Aims:
Cardiogenic shock (CS) is the deadliest manifestation of acute heart failure, with persistently high mortality rates and a lack of recent therapeutic breakthroughs. Accurate risk prediction is crucial in clinical decision-making and the design of future clinical trials. We aimed to validate the CLIP score, a biomarker-based risk score comprising cystatin C, lactate, interleukin-6 and NT-proBNP, for predicting mortality in acute coronary syndrome (ACS) related CS, and to compare its predictive value with the previously published CardShock risk score.
Methods And Results:
The study is a post hoc analysis of the CardShock Study, a prospective, observational European multicentre study on CS. The CLIP score was calculated 12 h after hospital admission, and its ability to predict 90-day mortality was assessed using are under the curve (AUC) of the receiver-operating characteristics (ROC) curve analysis. The discriminative ability of the CLIP score was compared with the CardShock risk score by comparing the AUC's. The cohort was dichotomized into low and high risk groups by the optimal cut-off value derived from the ROC analysis of the CLIP score. Kaplan-Meier curves were constructed to evaluate risk stratification when combining the CLIP and CardShock risk scores. The cohort (n = 121) comprised 77% (n = 93) men and the median age was 67 years (IQR 61-76). A total of 21% (n = 25) of the patients had non-ACS related CS. The CLIP score demonstrated appropriate predictive accuracy for 90-day mortality (AUC 0.84, 95% CI 0.77-0.91), comparable with the CardShock risk score (AUC 0.77 [95% CI 0.69-0.85]; P = 0.064 for comparison). A CLIP score cut-off of 0.28 stratified patients into high risk (65% mortality) and low risk (16% mortality) groups. In addition, incorporating the CLIP score enhanced risk stratification in all CardShock risk score categories.
Conclusions:
The CLIP score, calculated within 12 h of hospital admission, accurately predicted 90-day mortality in CS and complemented the CardShock risk score. The biomarker-based score has potential utility in dynamic mortality risk assessment and could inform clinical management and trial design.
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