title: Infectious Complications and Immune/Inflammatory Response in Cardiogenic Shock Patients: A Prospective Observational Study.
abstract: Patients with cardiogenic shock (CS) are at a high risk of developing infectious complications; however, their early detection is difficult, mainly due to a frequently occurring noninfectious inflammatory response, which accompanies an extensive myocardial infarction (MI) or a postcardiac arrest syndrome. The goal of our prospective study was to describe infectious complications in CS and the immune/inflammatory response based on a serial measurement of several blood-based inflammatory biomarkers.
  
  
  
  Eighty patients with CS were evaluated and their infections were monitored. Inflammatory markers (C-reactive protein, procalcitonin, pentraxin 3, presepsin) were measured seven times per week. The control groups consisted of 11 patients with ST segment elevation myocardial infarction without CS and without infection, and 22 patients in septic shock.
  
  
  
  Infection was diagnosed in 46.3% of patients with CS; 16 patients developed an infection within 48 h. Respiratory infection was most common, occurring in 33 out of 37 patients. Infection was a significant or even the main reason of death only in 3.8% of all patients with CS, and we did not find statistically significant difference in 3-month mortality between group of patients with CS with and without infection. There was no statistically significant prolongation of the duration of mechanical ventilation associated with infection. Strong inflammatory response is often in patients with CS due to MI, but we found no significant difference in the course of the inflammatory response expressed by evaluated biomarkers in patients with CS with and without infection. We found a strong relationship between the elevated inflammatory markers (sampled at 12 h) and the 3-month mortality: the area under the curve of receiver operating characteristic ranged between 0.683 and 0.875.
  
  
  
  The prevalence of infection in patients with CS was 46.3%, and respiratory tract infections were the most common type. Infections did not prolong statistically significantly the duration of mechanical ventilation and did not increase the prevalence of hospital mortality in this high-risk CS population. CS due to acute myocardial infarction was accompanied by a strong and highly variable inflammatory response, but it did not reach the intensity of the inflammatory response observed in patients with septic shock. An extensive immune/inflammatory response in patients with CS is linked to a poor prognosis.
authors.affiliation: *Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic †Faculty of Medicine, Masaryk University, Brno, Czech Republic ‡Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic §Department of Anaesthesiology and Intensive Care, University Hospital Brno, Brno, Czech Republic ¶Université Paris Diderot, PRES Sorbonne Paris Cité, France ||Department of Anaesthesiology and Critical Care and Burn unit, APHP, Saint Louis Lariboisière University Hospitals, Paris, France #U 942 INSERM, Paris, France **Department of Biochemistry, University Hospital Brno, Brno, Czech Republic ††Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic ‡‡Department of Clinical Immunology and Allergology, St Anne's University Hospital in Brno, Brno, Czech Republic §§Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic ¶¶Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic ||||Department of Anaesthesiology and Intensive Care, University Hospital Ostrava, Ostrava-Poruba, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
authors.forename: Jan
authors.initials: J
authors.lastname: Malaska
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Jana
authors.initials: J
authors.lastname: Gottwaldova
authors.forename: Katerina
authors.initials: K
authors.lastname: Helanova
authors.forename: Jiri
authors.initials: J
authors.lastname: Litzman
authors.forename: Milan
authors.initials: M
authors.lastname: Dastych
authors.forename: Josef
authors.initials: J
authors.lastname: Tomandl
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: Ludmila
authors.initials: L
authors.lastname: Dostalova
authors.forename: Petr
authors.initials: P
authors.lastname: Lokaj
authors.forename: Marie
authors.initials: M
authors.lastname: Tomandlova
authors.forename: Monika Goldergova
authors.initials: MG
authors.lastname: Pavkova
authors.forename: Pavel
authors.initials: P
authors.lastname: Sevcik
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000378:metabolism*; D002097:C-Reactive Protein / Q000235:genetics / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000276:immunology / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D000683:Serum Amyloid P-Component / Q000235:genetics / Q000378:metabolism; D012770:Shock, Cardiogenic / Q000097:blood / Q000276:immunology* / Q000378:metabolism*; D012772:Shock, Septic / Q000097:blood / Q000276:immunology / Q000378:metabolism; D000099153:Pentraxins
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D002116:Calcitonin; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; D000683:Serum Amyloid P-Component; D000099153:Pentraxins; C000594167:presepsin protein, human