Interleukin-6, -7, -8 and -10 predict outcome in acute myocardial infarction complicated by cardiogenic shock.
BACKGROUND
The IABP-SHOCK-trial was a morbidity-based randomized controlled trial in patients with infarction-related cardiogenic shock (CS), which used the change of the quantified degree of multiorgan failure as determined by APACHE II score over a 4-day period as primary outcome measure. The prospective hypothesis was that adding IABP therapy to "standard care" would improve CS-triggered multi organ dysfunction syndrome (MODS). The primary endpoint showed no difference between conventionally managed cardiogenic shock patients and those with IABP support. In an inflammatory marker substudy, we analysed the prognostic value of interleukin (IL)-1β, -6, -7, -8, and -10 in patients with acute myocardial infarction complicated by cardiogenic shock.


METHODS
Inflammatory marker substudy of the prospective, randomized, controlled, open label IABP-SHOCK-trial (ClinicalTrials.gov ID-NCT00469248).


METHODS
A single-center study was performed in a 12-bed Intensive-Care-Unit in an university hospital in which 40 consecutive patients were enrolled with an observational period of 96 h.


RESULTS
The pro- and anti-inflammatory markers IL-6, -7, -8 and -10 showed a predictive power for mortality of infarct-related CS patients, while IL-1β did not discriminate. The maximal values during the observational period, in case of IL-7 the minimal value, showed the best power to predict mortality. Both, ROC and multivariate analyses confirmed these suggestions (area under the curve: IL-8, 0.80 ± 0.08; IL-6, 0.79 ± 0.08; IL-10, 0.76 ± 0.08; IL-7, 0.69 ± 0.08). Inflammatory markers were not affected by the presence of IABP support.


CONCLUSIONS
The inflammatory response in patients with myocardial infarction complicated by cardiogenic shock, as reflected by the inflammatory markers IL-6, IL-7, IL-8 and IL-10, demonstrates a clinically relevant prognostic contribution to clinical outcome.
Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany. r.prondzinsky@klinikum-saalekreis.de
Roland
R
Prondzinsky
Susanne
S
Unverzagt
Henning
H
Lemm
Nikolas-Arne
NA
Wegener
Axel
A
Schlitt
Konstantin M
KM
Heinroth
Sebastian
S
Dietz
Ute
U
Buerke
Patrick
P
Kellner
Harald
H
Loppnow
Martin G
MG
Fiedler
Joachim
J
Thiery
Karl
K
Werdan
Michael
M
Buerke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D015851:Interleukin-7 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007378:Interleukins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D015425:Myocardial Reperfusion / Q000009:adverse effects; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000097:blood* / Q000209:etiology / Q000401:mortality
D015415:Biomarkers; D015850:Interleukin-6; D015851:Interleukin-7; D016209:Interleukin-8; D007378:Interleukins; D016753:Interleukin-10