Background: Plasmatic procalcitonin (PCT) is an acute-phase inflammatory marker, its value tends to increase during inflammatory conditions such as septic shock, cardiogenic shock (CS) and bacterial infections. Patients with CS complicating acute myocardial infarction (AMI) and signs of systemic inflammatory response syndrome (SIRS) can show increased PCT values but its prognostic role in this setting is still unknown.
Purpose: evalute prognostic role of plasmatic PCT in an ischemic CS population.
Methods: All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single-centre retrospective study. We evaluated PCT and C reactive protein (CRE) values in blood sample only in patients with clinical signs of SIRS or infection. Microbiological examination were also collected to exclude a bacterial infection.
Results: We included 167 patients [males 67%; mean age 71 years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5,2 (3,1-8,8) mmol/L. All patients required inotropes while 91,1% required mechanical cardiac support (MCS). The overall in-hospital mortality rate was 46%. The PCT values resulted to be an in-hospital mortality predictor at multivariate analysis (p = 0,018) and we observed a generally lower PCT values in surviving CS patients (Fig 1). At the analysis the optimal maximum PCT cut-off value to predict in-hospital mortality was 5,77 ng/l (SE 0,82; SP 0,72, accuracy 0,78) with an area under the receiver operating characteristic curve of 0.80 (Fig 2). Moreover positivity to microbiological examination such as urine colture, blood colture, bronchoalveolar lavage and maximum CPR values were not associated with in-hospital death at univariable analysis.
Conclusions: in our retrospective study we found that PCT is an in-hospital mortality predictor and values greater than 5,77 ng/ml seem to be a good indicator of patients with poor prognosis in ischemic CS patients. High PCT values could have a role in indentifing CS patients with a intense SIRS or with a septic shock component which is associated with a even higher in-hospital mortality rate. The positivity to microbiological examination and maximum CPR values weren’t death predictors in our sample. Further studies in larger CS population could be advisable to better define prognostic role of PCT and evaluate its role in CICU daily clinical practice.