title: Activated protein C levels and outcome in patients with cardiogenic shock complicating acute myocardial infarction.
abstract: BACKGROUND
  In patients with severe sepsis, low levels of activated protein C are associated with high morbidity and mortality. In an observational study we investigated whether patients with cardiogenic shock have decreased circulatory levels of activated protein C, and if these are associated with increased mortality.
  
  
  METHODS
  We measured serum activated protein C and interleukin-6 levels in 43 patients with cardiogenic shock following acute myocardial infarction and in 15 control patients with uncomplicated myocardial infarction at days 0-5 and 7 after the onset of shock/myocardial infarction.
  
  
  RESULTS
  Activated protein C levels were significantly lower in patients with cardiogenic shock compared to controls. In cardiogenic shock patients, there was no difference in activated protein C levels at baseline, whereas activated protein C levels significantly declined in 28-day non-survivors at day 2, compared with 28-day survivors. Lower levels of activated protein C were associated with a higher degree of vasopressor need, whereas there was no significant association with multiple organ failure in the first days. Regarding the inflammatory response, a strong inverse correlation was observed between interleukin-6 and activated protein C levels.
  
  
  CONCLUSIONS
  Patients with cardiogenic shock who did not survive up to 28 days showed a decline in activated protein C levels during the course of the disease, which was inversely correlated with interleukin-6. This study underlines sustained inflammatory mechanisms in the development and persistence of cardiogenic shock, highlighting a potential effect of anti-inflammatory interventions early during cardiogenic shock.
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fellner
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Miklos
authors.initials: M
authors.lastname: Rohla
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Smetana
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Matthias K
authors.initials: MK
authors.lastname: Freynhofer
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Egger
authors.affiliation: 2 Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Zorn
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Weiss
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: 1 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Geppert
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011486:Protein C / Q000032:analysis*; D012770:Shock, Cardiogenic / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy; D014336:Troponin / Q000032:analysis; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D011486:Protein C; D014336:Troponin; D014662:Vasoconstrictor Agents
keywords: Cardiogenic shock; activated protein C; acute myocardial infarction