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Exploring the Significance of Procalcitonin in Cardiogenic Shock for the Prediction of Infection and Mortality Outcomes
Session:
Sessão de Posters 20 - Doença coronária - marcadores de prognóstico
Speaker:
Débora Silva Correia
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type:
Cartazes
FP Number:
---
Authors:
Débora Da Silva Correia; Samuel Azevedo; João Presume; Ana Rita Bello; Rita Barbosa Sousa; Miguel Domingues; Joana Certo Pereira; Maria Rita Lima; Catarina Brízido; Christopher Strong; Jorge Ferreira; António Tralhão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>[Introduction]</strong>: Both insult severity and treatment invasiveness of cardiogenic shock (CS) increase patients’ infectious risk, which in turn may worsen an already adverse baseline prognosis. However, the frequent inflammatory response associated with some CS phenotypes makes the distinction between sterile inflammation and infection troublesome. To this end, procalcitonin (PCT), an infection biomarker validated in other critical illness contexts, could provide useful mechanistic and prognostic information.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>[Aim]</strong>: To explore the role of PCT in distinguishing between inflammation and infection in early-stage CS and evaluate its prognostic value.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>[Methods]</strong>: This was a single-center, retrospective study, including all consecutive CS patients admitted to a cardiac intensive care unit (CICU), between June 2020 and October 2023, with PCT measurement on admission. Patient records were screened for value of biomarkers at admission and selected infections over the first 72 hours: bacteraemia based on positive blood cultures, and hospital-acquired or ventilator-associated tracheobronchitis or pneumonia, according to a composite of clinical and radiologic criteria. Discriminative power of admission PCT, leucocyte count (Leuc) and C-reactive protein (CRP) for the occurrence of infection over the first 72-hours was analysed through ROC curve analysis. Finally, PCT predictive value on 30-day mortality was analysed through Cox regression and Kaplan-Meier curves, according to the best PCT cut-off for death prediction.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">[<strong>Results]</strong>: A total of 115 patients had at a PCT evaluation available (mean age 61±16 years; 71% male; 31% with SCAI ≥D at admission; 46% with acute myocardial infarction). Median PCT was 0.66 (IQR 0.18-0.66) ng/mL. The rate of infection diagnosis during the first 72-hours was 22% (n=25). ROC curve analysis revealed poor discriminative power of the considered biomarkers for predicting infection at 72 hours (PCT<sub>AUC</sub> 0.467 [CI 95% 0.345-0.586], p=0.598; CRP<sub>AUC </sub>0.507 [CI 95%0.375-0.639], p=0.915; Leuc<sub>AUC</sub> 0.411 [CI 95% 0.281-0.0553], p=0.206). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">30-day mortality was 39% (n=45) and was numerically higher in patients with infections (48 vs. 37%, p=0.302). Dichotomous survival analysis based on the most discriminative PCT cut-off for 30-day mortality (0.47 ng/mL, obtained through ROC curve inspection), did not show differences between subgroups (36% vs. 27%, p=0.367). Even after adjusting for the severity of CS according to SCAI class, PCT levels still did not show an association with increased 30-day mortality [HR 1.176 (CI 95% 0.646-2.142), p=0. 596].</span></span></p> <p style="text-align:justify"> </p> <p><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">[<strong>Conclusion]</strong>: Within this group of patients with CS, an elevated PCT was unable to correctly identify the presence of infection or correlate with increased mortality. Prospective, larger studies are required to assess the reproducibility of these findings. </span></span></p>
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