Interleukin-6 is the strongest predictor of 30-day mortality in patients with cardiogenic shock due to myocardial infarction

Abstract

IntroductionCardiogenic shock (CS) remains the leading cause of death in patients hospitalized for myocardial infarction (MI). Systemic inflammation with inappropriate vasodilatation is observed in many patients with CS and may contribute to an excess mortality rate. The purpose of this study was to determine the predictive role of serial measurements of Nt-proBNP, interleukin-6 (IL-6), and procalcitonin (PCT) for 30-day mortality in patients with CS due to MI.MethodsThe present study is a prospective single-center study including 87 patients with MI complicated by CS treated with acute revascularization and intraaortic balloon counterpulsation (IABP) support. Predictive values of plasma levels at admission (T0), after 24 hours (T1), and after 72 hours (T2) were examined according to 30-day mortality.ResultsSignificant differences between survivors (n = 59) and nonsurvivors (n = 28) were seen for Nt-proBNP at T0, for IL-6 at T0 and T1, and for PCT at T1 and T2. According to ROC analyses, the highest accuracy predicting 30-day mortality was seen at T0 for IL-6, at T1 for PCT, and at T2 for PCT. In univariate analysis, significant values were found for Nt-proBNP at T1, and for IL-6 and PCT at all points in time. Within the multivariate analysis, age, creatinine, and IL-6 were significant determinants of 30-day mortality, in which IL-6 showed the highest level of significance.ConclusionsIn patients with MI complicated by CS, IL-6 represented a reliable independent early prognostic marker of 30-day mortality. PCT revealed a significant value at later points in time, whereas Nt-proBNP seemed to be of lower relevance.

Differential responses to larger volume intra‐aortic balloon counterpulsation: Hemodynamic and clinical outcomes

“…Despite promising early results [15], subsequent randomized controlled studies failed to demonstrate a mortality benefit [16,17]. A number of cytokines are involved in the cascade of inflammation that accompanies severe cardiogenic shock, and it is likely that there are shared characteristics between cardiogenic and septic shock [18][19][20][21][22][23][24].…”

Inflammation and ER Stress Downregulate BDH2 Expression and Dysregulate Intracellular Iron in Macrophages

“…Previous study showed that treatment with anti-IL-6 antibody lowered hepcidin levels which alleviated hypoferremia and restored iron homeostasis [ 2 , 69 ]. Among many inflammatory mediators IL-6 is a predictor of mortality in chronic kidney disease [ 70 ], in HIV [ 71 ], and in other chronic diseases associated with immune activation due to microbial translocation [ 72 , 73 ]. Our results suggest that ER stress combined with inflammation increases IL-6 that induces hepcidin expression leading to increased intracellular iron which downregulates BDH2 expression.…”

Interleukin 6 at reperfusion: A potent predictor of hepatic and extrahepatic early complications after liver transplantation

“…Recent works on acute‐on‐chronic liver failure have shown high cytokine levels . The prognostic value of IL‐6 levels has already been demonstrated in other acute situations such as ICU patients after cardiac and septic shock as well as in trauma patients . SIRS and sepsis may explain higher IL‐6 levels both in the pre‐ and immediate posttransplant setting.…”