title: Early assessment of outcome in cardiogenic shock: relevance of plasma N-terminal pro-B-type natriuretic peptide and interleukin-6 levels.
abstract: OBJECTIVE
  Plasma N-terminal pro-B-type natriuretic peptide (Nt-pro-BNP) levels are frequently elevated in critically ill patients and are associated with an increased mortality. In this study, we determined Nt-pro-BNP levels in patients with cardiogenic shock (CS) and evaluated its association with clinical and hemodynamic parameters and 30-day mortality.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Two, eight-bed intensive care units at a university and a community hospital.
  
  
  METHODS
  Retrospective study on stored plasma samples of 58 patients with CS, obtained at admission to the intensive care unit.
  
  
  METHODS
  None.
  
  
  RESULTS
  Massively elevated Nt-pro-BNP concentrations showed no significant association with duration of shock, total Sequential Organ Failure Assessment score, or invasive hemodynamic parameters at the time of blood sampling but a significant association with estimated glomerular filtration rate (p < 0.001), C-reactive protein (p = 0.03), age (p = 0.005), and body weight (p = 0.03). Both in univariate and multivariate survival analyses, Nt-pro-BNP levels above the median (>12,782 pg/mL) were significant predictors of 30-day mortality (p < 0.001) and showed a complementary role with interleukin (IL)-6 in predicting outcome. Patients with IL-6 >195 pg/mL and Nt-pro-BNP above the median value had the highest 30-day mortality (93.7%), whereas patients with lower IL-6 levels together with lower Nt-pro-BNP levels had significantly better survival (mortality rate 26.3%). Among patients who had acute myocardial infarction, those with Nt-pro-BNP concentrations above the median level showed a highly impaired clinical course even if coronary revascularization was successful (30-day mortality 90.9% vs. 29.4%, p = 0.001), whereas survival of patients with unsuccessful revascularization did not differ significantly with respect to the median of Nt-pro-BNP (30-day survival rate 81.8% vs. 75.0%, p = 0.71).
  
  
  CONCLUSIONS
  The massive elevations of Nt-pro-BNP observed in the early phase of CS seem to be independent of ventricular performance. Nt-pro-BNP levels are nevertheless predictive of 30-day survival in patients with CS especially in those with successful revascularization and might be used in combination with IL-6 for estimation of outcome early on.
authors.affiliation: 3rd Department of Medicine with Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.forename: Barbara
authors.initials: B
authors.lastname: Fellner
authors.forename: Diana
authors.initials: D
authors.lastname: Haoula
authors.forename: Nelly
authors.initials: N
authors.lastname: Jordanova
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
authors.forename: Georg Delle
authors.initials: GD
authors.lastname: Karth
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Alexander
authors.initials: A
authors.lastname: Geppert
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D009204:Myocardial Revascularization; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000097:blood* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain