Dynamics of interleukin 6 levels in the patients with cardiogenic and septic shock and in a control group of patients with uncomplicated AMI
Authors:
Jiří Pařenica 1,3; Jan Maláska 4; Jiří Jarkovský 5; Kateřina Helánová 3; Petr Jabandžiev 2; Jaroslav Michálek 2; Zuzana Veselková 2; Simona Littnerová 5; Lenka Kubková 1,3; Roman Gál 4; Pavel Ševčík 6; Monika Pávková Goldbergová 7; Jiří Litzman 8; Zdena Čermáková 9,10; Jindřich Špinar 1,3
Authors‘ workplace:
Interní kardiologická klinika LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC
1; Lékařská fakulta MU, Brno, děkan prof. MUDr. Jiří Mayer, CSc.
2; Mezinárodní centrum klinického výzkumu FN u sv. Anny, Brno, ředitel Gorazd B. Stokin, M. D., MSc., Ph. D.
3; Klinika anesteziologie, resuscitace a intenzivní medicíny LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Roman Gál, Ph. D.
4; Institut biostatistiky a analýz LF MU, Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D.
5; Klinika anesteziologie, resuscitace a intenzivní medicíny FN Ostrava, přednosta prof. MUDr. Pavel Ševčík, CSc.
6; Ústav patologické fyziologie LF MU, Brno, přednostka prof. MUDr. Anna Vašků, CSc.
7; Ústav klinické imunologie a alergologie LF MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Jiří Litzman, CSc.
8; Oddělení klinické biochemie FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Milan Dastych, CSc., MBA
9; Katedra laboratorních metod LF MU, Brno, přednosta doc. MUDr. Milan Dastych, CSc., MBA
10
Published in:
Vnitř Lék 2014; 60(2): 114-122
Category:
Original Contributions
Overview
Introduction:
Cardiogenic shock (CS) is the leading cause of mortality in patients with acute myocardial infarction (AMI). Inflammatory response seems to be common response in patients with AMI, especially those with CS. We have therefore conducted a study to determine diagnostic and prognostic utility of interleukin 6 (IL6) levels in the cohort of patients with cardiogenic and septic shock (SS) and in a control group of patients with uncomplicated AMI.
Methods:
In this prospective study 71 patients fulfilled the inclusion criteria: 30 patients with cardiogenic shock, 21 patients with septic shock and 20 patients with ST elevation myocardial infarction (STEMI). Plasma levels of IL6 were measured at 8 time points. The main endpoint was 3 month mortality.
Results:
We have shown that the highest IL6 levels during the first week were recorded in patients with septic shock with peak value at admission. The maximum level of IL6 was detected between 12 to 24 hours after the onset of MI among patients with cardiogenic shock. According to Receiver operating characteristic (ROC) statistics levels of IL6 > 357 pg/ml at admission (AUC 0.730, p = 0.031) were typical for patients with CS in comparison with control group of STEMI patients. Values of IL6 > 1 237 pg/ml at admission and > 1 071 pg/ml at 24 hours (after admission?) were typical for thouse in septic shock in comparison with CS patients. We found only a non-significant trend of IL6 for the prediction of mortality in the cohort of CS patients for levels ≥ 1 854 pg/ml (AUC 0.769, p = 0.066) sampled 12 hours after admission. There was no association of plasma levels of IL6 with mortality in septic shock patients.
Conclusions:
Patients with cardiogenic shock demonstrated more pronounced cytokine response as evidenced by increased levels of IL6 compared to patients with uncomplicated STEMI. Levels of IL6 peaked in SS patients at admission, in CS patients 12–24 hours after admission. In daily clinical practice routine measurement of IL6 levels for prediction of prognosis both in cardiogenic and septic shock are of little value mainly due to significant interindividual variability of IL6 values.
Keywords:
cardiogenic shock – interleukin 6 – myocardial infarction – predictor – prognostic – septic shock
Sources
1. Hochman JS, Buller CE, Sleeper LA et al. Cardiogenic shock complicating acute myocardial infarction--etiologies, management and outcome: a report from the SHOCK Trial Registry. J Am Coll Cardiol 2000; 36: (3 Suppl A): 1063–1070.
2. Spinar J, Parenica J, Vitovec J et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry. Critical Care 2011; 15(6): R291.
3. Kala P, Miklik R. Pharmaco-mechanic Antithrombotic Strategies to Reperfusion of the Infarct-Related Artery in Patients with ST-Elevation Acute Myocardial Infarctions. J Cardiovasc Transl Res 2013; 6(3): 378–387.
4. Kohsaka S, Menon V, Lowe AM et al. Systemic Inflammatory Response Syndrome After Acute Myocardial Infarction Complicated by Cardiogenic Shock. Arch Intern Med 2005; 165(4): 1643–1650.
5. Griselli M, Herbert J, Hutchinson WL et al. C-Reactive Protein and Complement Are Important Mediators of Tissue Damage in Acute Myocardial Infarction. J Exp Med 1999; 190(12): 1733–1740.
6. Pietllä KO, Harmoinen AP, Jokiniitty J et al. Serum C-reactive protein concentration in acute myocardial infarction and its relationship to mortality during 24 months of follow-up in patients under thrombolytic treatment. Eur Heart J 1996; 17(9): 1345–1349.
7. Theroux P, Armstrong PW, Mahaffey KW et al. Prognostic significance of blood markers of inflammation in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty and effects of pexelizumab, a C5 inhibitor: a substudy of the COMMA trial. Eur Heart J 2005; 26(19): 1964–1970.
8. Geppert A, Dorninger A, Delle-Karth G et al. Plasma concentrations of interleukin-6, organ failure, vasopressor support, and successful coronary revascularization in predicting 30-day mortality of patients with cardiogenic shock complicating acute myocardial infarction. Crit Care Med 2006; 34(8): 2035–2042.
9. Geppert A, Steiner A, Zorn G et al. Multiple organ failure in patients with cardiogenic shock is associated with high plasma levels of interleukin-6. Crit Care Med 2002; 30(9): 1987–1994.
10. Pinsky MR, Vincent JL, Deviere J et al. Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality. Chest 1993; 103(2): 565–575.
11. Wu HP, Chen CK, Chung K et al. Serial cytokine levels in patients with severe sepsis. Inflamm Res 2009; 58(7): 385–393.
12. Mera S, Tatulescu D, Cismaru C et al. Multiplex cytokine profiling in patients with sepsis. APMIS 2011; 119(2): 155–163.
13. Bozza F, Salluh J, Japiassu A et al. Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care 2007; 11(2): R49.
14. Kellum JA, Kong L, Fink MP et al. Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study. Arch Intern Med 2007; 167(15): 1655–1663.
15. Levy MM, Fink MP, Marshall JC et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003; 29(4): 530–538.
16. Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 1992; 101(6): 1481–1483.
17. Alexander JH, Reynolds HR, Stebbins AL et al. Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 2007; 297(15): 1657–1666.
18. Steg P, James SK, Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33(20): 2569–2619.
19. Knaus WA, Draper EA, Wagner DP et al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13(10): 818–829.
20. Brunkhorst F, Clark A, Forycki Z et al. Pyrexia, procalcitonin, immune activation and survival in cardiogenic shock: the potential importance of bacterial translocation. Int J Cardiol 1999; 72(1): 3–10.
21. Pudil R, Krejsek J, Pidrman V et al. Inflammatory response to acute myocardial infarction complicated by cardiogenic shock. Acta Medica (Hradec Kralove) 2001; 44(4): 149–151.
22. Matejovic M, Chvojka J, Sykora R et al. A 24-h work shift in intensive care personnel: biological pathways between work stress and ill health. J Int Med Res 2011; 39(2): 629–636.
23. Kula R, Chýlek V, Sklienka P et al. Balíčky péče pro těžkou sepsi. Postgraduální medicína 2001; 12: 1048–1051.
24. Hosnijeh FS, Krop EJ, Portengen L et al. Stability and reproducibility of simultaneously detected plasma and serum cytokine levels in asymptomatic subjects. Biomarkers 2010; 15(2): 140–148.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2014 Issue 2
Most read in this issue
- MRI compatible cardiac pacemakers and implantable cardioverter defibrillators
- Dynamics of interleukin 6 levels in the patients with cardiogenic and septic shock and in a control group of patients with uncomplicated AMI
- Catheter Related Septic Central Venous Thrombosis of the Superior Vena Cava and Right Atrium
- The place of JAK2 inhibitors in the treatment of myelofibrosis. An amendment to the recommendations for diagnosis and treatment of Ph negative myeloproliferations of the Czech group for Ph- myeloproliferative disorders (CZEMP)