Abstract 16598: Time Course and Predictive Value of Interleukin-Release in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
Background In patients with septic shock prognosis is associated with systemic inflammation as indicated by elevated levels of proinflammatory markers such as IL-6 and TNF-α . In this inflammatory marker substudy of the randomized IABP-SHOCK-Trial (Clinical Trials.gov ID NCT00469248) we analyzed a broad spectrum of lnterleukins to determine their prognostic value in CS in total and especially with respect to subpopulations (IABP-support, CPR, impaired renal function and also according to age and gender).
Material and Methods During the observational period from admission up to 96 hrs a complete dataset (blood samples, APACHE II scores, hemodynamics) of 40 patients with infarct related CS was obtained and analyzed.
Results While the interleukins IL-6, IL-8, and IL-10 showed a significant impact for discrimination, IL-7 showed an independent high, but non-significant contribution to prognosis. IL-1β, IL-2, IL-4, IL-5, IL-12, IL13, IL-17 showed no or only minor changes over 96 hours. Comparing initial and maximal values, the maximal values (minimal for IL-7) over 96 hours showed for most of the reacting markers the best predictive power. The ROC-analysis showed the following areas under the curves non survivors: IL8 (max.) 0.80±0.08, IL-6 (max.) AUC=0.79±0.08, IL10 (max) AUC=0.76±0.08 IL-7 (min.) AUC: 0.69±0.08. In addition IABP did not affect inflammatory markers. Impaired renal function was associated with similar levels of IL-7 at 24, 48, 72 and 96 hours, while IL-6, IL8 and IL-10 on admission could discriminate between all three subgroups (IL-6: CreaLCl<30 ml/min: 2861±2066 pg/dl; CreaCl 30–60 ml/min: 545±203 pg/dl; CreaCl>60 ml/min: 86±30 pg/dl p=0.023; IL-8: CreaLCl<30 ml/min: 11.3±4.0 pg/dl; CreaCl 30–60 ml/min: 2.9±0.8 pg/dl; CreaCl>60 ml/min: 1.8±0.2 pg/dl p=0.004; IL-10: CreaLCl< 30ml/min: 118±45 pg/dl; CreaCl 30–60 ml/min: 37±17 pg/dl; CreaCl>60 ml/min: 12±8 pg/dl p=0.001). Further, prior CPR, age (<75y or ≥75y) and gender did not affect levels of IL-6, IL-7, IL-8, and IL-10 in cardiogenic shock patients
Conclusion Inflammation shows a significant predictive value for the discrimination of survivors and non-survivors and also for other subgroups of infarct-related CS on admission and during the whole time course.
- © 2010 by American Heart Association, Inc.