Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock
Por:
Tolppanen, H, Rivas-Lasarte, M, Lassus, J, Sans-Rosello, J, Hartmann, O, Lindholm, M, Arrigo, M, Tarvasmaki, T, Kober, L, Thiele, H, Pulkki, K, Spinar, J, Parissis, J, Banaszewski, M, Silva-Cardoso, J, Carubelli, V, Sionis, A, Harjola, VP, Mebazaa, A
Publicada:
4 ene 2017
Resumen:
Background: The clinical CardShock risk score, including baseline lactate levels, was recently shown to facilitate risk stratification in patients with cardiogenic shock (CS). As based on baseline parameters, however, it may not reflect the change in mortality risk in response to initial therapies. Adrenomedullin is a prognostic biomarker in several cardiovascular diseases and was recently shown to associate with hemodynamic instability in patients with septic shock. The aim of our study was to evaluate the prognostic value and association with hemodynamic parameters of bioactive adrenomedullin (bio-ADM) in patients with CS.
Methods: CardShock was a prospective, observational, European multinational cohort study of CS. In this sub-analysis, serial plasma bio-ADM and arterial blood lactate measurements were collected from 178 patients during the first 10 days after detection of CS.
Results: Both bio-ADM and lactate were higher in 90-day non-survivors compared to survivors at all time points (P < 0.05 for all). Lactate showed good prognostic value during the initial 24 h (AUC 0.78 at admission and 0.76 at 24 h). Subsequently, lactate returned normal (<= 2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5-10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (> 55.7 pg/mL) at 48 h compared to those with low bio-ADM levels (49.1 vs. 22.6%, P = 0.001). High levels of bio-ADM were associated with impaired cardiac index, mean arterial pressure, central venous pressure, and systolic pulmonary artery pressure during the study period. Furthermore, high levels of bio-ADM at 48 to 96 h were related to persistently impaired cardiac and end-organ function.
Conclusions: Bio-ADM is a valuable prognosticator and marker of impaired hemodynamics in CS patients. High levels of bio-ADM may show shock refractoriness and developing end-organ dysfunction and thus help to guide therapeutic approach in patients with CS.
Filiaciones:
Tolppanen, H:
INSERM, UMR S942, Paris, France
Paijat Hame Cent Hosp, Ctr Heart, Lahti, Finland
Univ Helsinki, Heart & Lung Ctr, Helsinki, Finland
Helsinki Univ Hosp, Helsinki, Finland
Rivas-Lasarte, M:
INSERM, UMR S942, Paris, France
Univ Autonoma Barcelona, Biomed Res Inst IIBSantPau, Hosp Santa Creu & St Pau, Intens Cardiac Care Unit,Cardiol Dept, Barcelona, Spain
Lassus, J:
Univ Helsinki, Heart & Lung Ctr, Helsinki, Finland
Helsinki Univ Hosp, Helsinki, Finland
Sans-Rosello, J:
Univ Autonoma Barcelona, Biomed Res Inst IIBSantPau, Hosp Santa Creu & St Pau, Intens Cardiac Care Unit,Cardiol Dept, Barcelona, Spain
Hartmann, O:
Sphingotec GmbH, Hennigsdorf, Germany
Lindholm, M:
Univ Copenhagen, Dept Cardiol, Rigshosp, Copenhagen, Denmark
Arrigo, M:
INSERM, UMR S942, Paris, France
Univ Heart Ctr, Dept Cardiol, CH-8091 Zurich, Switzerland
Univ Hosp Zurich, Dept Cardiol, CH-8091 Zurich, Switzerland
Tarvasmaki, T:
Helsinki Univ Hosp, Helsinki, Finland
Univ Helsinki, Dept Emergency Care, Helsinki, Finland
Thiele, H:
Univ Heart Ctr Lubeck, Med Clin 2, Univ Hosp Schleswig Holstein, Lubeck, Germany
Pulkki, K:
Univ Eastern Finland, Dept Clin Chem, Kuopio, Finland
Eastern Finland Lab Ctr, Kuopio, Finland
Spinar, J:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
ICRC, Brno, Czech Republic
Parissis, J:
Attikon Univ Hosp, Heart Failure Clin, Athens, Greece
Attikon Univ Hosp, Secondary Cardiol Dept, Athens, Greece
Banaszewski, M:
Inst Cardiol, Intens Cardiac Therapy Clin, Warsaw, Poland
Silva-Cardoso, J:
Univ Porto, Porto Med Sch, Sao Joao Hosp Ctr, Dept Cardiol,CINTESIS, Oporto, Portugal
Carubelli, V:
Univ & Civil Hosp Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlt, Div Cardiol, Brescia, Italy
Sionis, A:
Univ Autonoma Barcelona, Biomed Res Inst IIBSantPau, Hosp Santa Creu & St Pau, Intens Cardiac Care Unit,Cardiol Dept, Barcelona, Spain
Harjola, VP:
Helsinki Univ Hosp, Helsinki, Finland
Univ Helsinki, Dept Emergency Care, Helsinki, Finland
Mebazaa, A:
INSERM, UMR S942, Paris, France
Univ Hosp St Louis Lariboisiere, AP HP, Dept Anesthesia & Crit Care, Paris, France
Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
Green Published, gold
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