Dipeptidyl Amino-Peptidase 3 (DPP3) as an Early Marker of Severity in a Patient Population with Cardiogenic Shock

Abstract

Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase that is released into circulation upon cell death. DPP3 is involved in the degradation of angiotensins, enkephalines, and endomorphines. It has been shown that circulating DPP3 (cDPP3) plasma concentration increases in cardiogenic shock (CS) patients and correlates with high mortality risk. Cardiogenic shock is a life-threatening syndrome associated with organ hypoperfusion. One of the common causes of CS is acute myocardial infarction (AMI). This study aimed to investigate if cDPP3 levels are associated with CS severity and the need for ventilation in patients suffering from CS. Fifteen patients with CS were included in this study. Six patients were invasively ventilated. The values of cDPP3 were higher in ventilated patients than in non-ventilated patients at admission, 3 h, and 24 h after admission in the intensive care unit. Patients with pulmonary hypertension at admission also showed high cDPP3 values at all time points. Furthermore, high cDPP3 levels were associated with reduced stroke volume. Our results suggest that cDPP3 could predict CS progression and guide therapy escalation.

Extending the ‘host response’ paradigm from sepsis to cardiogenic shock: evidence, limitations and opportunities

“…In vivo cDPP3 levels were measured in patients recruited to the multi-centre Optima CC trial [46] comparing epinephrine versus norepinephrine for haemodynamic support in CS [74]. High levels of cDPP3 (> 51.9 ng/ml) were associated with greater risk of death at 90 days, greater organ dysfunction and lower cardiac index, findings which have been confirmed in subsequent observational studies [75,76]. A large multicentre, prospective study investigating the role of cDPP3 in acute coronary syndromes (ACS) found that high levels were independently predictive of the development of in-hospital CS (HR 1.49, 95% CI 1.14-1.96, P = 0.004) [52].…”