Validation of a biomarker-based mortality score for cardiogenic shock patients: Comparison with a clinical risk score
Por:
Hynninen, E, Tolppanen, H, Rivas-Lasarte, M, Tarvasmaeki, T, Harjola, VP, Deniau, B, Hongisto, M, Jankowska, EA, Jurkko, R, Jaentti, T, Kataja, A, Mebazaa, A, Sabell, T, Sionis, A, Lassus, J
Publicada:
1 jun 2025
Ahead of Print:
1 feb 2025
Resumen:
AimsCardiogenic 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 resultsThe 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.ConclusionsThe 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.
Filiaciones:
Hynninen, E:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Tolppanen, H:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Rivas-Lasarte, M:
Hosp Univ Puerta Hierro, Dept Cardiol, IDIPHISA, CIBER CV, Majadahonda, Spain
Tarvasmaeki, T:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Harjola, VP:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med, Dept Emergency Med & Serv, Helsinki, Finland
Deniau, B:
Univ Hosp St Louis Lariboisiere, AP HP, Dept Anesthesiol Crit Care & Burn Unit, Paris, France
Hongisto, M:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med, Dept Emergency Med & Serv, Helsinki, Finland
Jankowska, EA:
Wroclaw Med Univ, Univ Hosp Wroclaw, Inst Heart Dis, Wroclaw, Poland
Jurkko, R:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Jaentti, T:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Kataja, A:
Wroclaw Med Univ, Univ Hosp Wroclaw, Inst Heart Dis, Wroclaw, Poland
Mebazaa, A:
Univ Paris Cite, Dept Anesthesia & Crit Care, APHP, Inserm MASCOT,FHU PROMICE, Paris, France
Sabell, T:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Sionis, A:
Hosp St Creu i St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Lassus, J:
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Green Submitted, gold
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