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Ceglarek, Uta; Schellong, Paul; Rosolowski, Maciej; Scholz, Markus; Willenberg, Anja; Kratzsch, Jürgen; Zeymer, Uwe; Fuernau, Georg; de Waha-Thiele, Suzanne; Büttner, Petra; Jobs, Alexander; Freund, Anne; Desch, Steffen; Feistritzer, Hans-Josef; Isermann, Berend; Thiery, Joachim; Pöss, Janine; Thiele, Holger

The novel cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide (CLIP)-based mortality risk score in cardiogenic shock after acute myocardial infarction

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  • Medientyp: E-Artikel
  • Titel: The novel cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide (CLIP)-based mortality risk score in cardiogenic shock after acute myocardial infarction
  • Beteiligte: Ceglarek, Uta; Schellong, Paul; Rosolowski, Maciej; Scholz, Markus; Willenberg, Anja; Kratzsch, Jürgen; Zeymer, Uwe; Fuernau, Georg; de Waha-Thiele, Suzanne; Büttner, Petra; Jobs, Alexander; Freund, Anne; Desch, Steffen; Feistritzer, Hans-Josef; Isermann, Berend; Thiery, Joachim; Pöss, Janine; Thiele, Holger
  • Erschienen: Oxford University Press (OUP), 2021
  • Erschienen in: European Heart Journal
  • Sprache: Englisch
  • DOI: 10.1093/eurheartj/ehab110
  • ISSN: 0195-668X; 1522-9645
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background </jats:title><jats:p>Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) still reaches excessively high mortality rates. This analysis is aimed to develop a new easily applicable biomarker-based risk score.</jats:p></jats:sec><jats:sec><jats:title>Methods and results </jats:title><jats:p>A biomarker-based risk score for 30-day mortality was developed from 458 patients with CS complicating AMI included in the randomized CULPRIT-SHOCK trial. The selection of relevant predictors and the coefficient estimation for the prognostic model were performed by a penalized multivariate logistic regression analysis. Validation was performed internally, internally externally as well as externally in 163 patients with CS included in the randomized IABP-SHOCK II trial. Blood samples were obtained at randomization. The two trials are registered with ClinicalTrials.gov (NCT01927549 and NCT00491036), are closed to new participants, and follow-up is completed. Out of 58 candidate variables, the four strongest predictors for 30-day mortality were included in the CLIP score (cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide). The score was well calibrated and yielded high c-statistics of 0.82 [95% confidence interval (CI) 0.78–0.86] in internal validation, 0.82 (95% CI 0.75–0.89) in internal-external (temporal) validation, and 0.73 (95% CI 0.65–0.81) in external validation. Notably, it outperformed the Simplified Acute Physiology Score II and IABP-SHOCK II risk score in prognostication (0.83 vs 0.62; P &amp;lt; 0.001 and 0.83 vs. 0.76; P = 0.03, respectively).</jats:p></jats:sec><jats:sec><jats:title>Conclusions </jats:title><jats:p>A biomarker-only score for 30-day mortality risk stratification in infarct-related CS was developed, extensively validated and calibrated in a prospective cohort of contemporary patients with CS after AMI. The CLIP score outperformed other clinical scores and may be useful as an early decision tool in CS.</jats:p></jats:sec>
  • Zugangsstatus: Freier Zugang