Associate Professor University Health Network Toronto, Ontario, Canada
Disclosure(s):
Adriana Luk: No financial relationships to disclose
Background: Cardiogenic shock (CS) is a proinflammatory state. Previous studies evaluating cytokines in CS have been limited by small sample sizes and incomplete cytokine profiling. We sought to interrogate the association of a comprehensive cytokine panel with CS mortality in a large multicenter cohort.
Methods: We enrolled 283 patients with CS admitted to one of four quaternary care referral centers in the VANQUISH Shock multicenter cohort study from 2022-2025. Peripheral blood at CS onset was used to quantify the concentration of 48 different cytokines via a multi-analyte Luminex assay. The association of cytokine levels at CS onset with in-hospital mortality was assessed via multivariable Cox proportional hazard models adjusted for age, sex, cardiac arrest, and CS etiology. A p< 0.05 was considered exploratory, while a more conservative false discovery rate (FDR) < 0.05 was considered confirmatory.
Outcome: 190 male patients were enrolled (67 %), 54 with acute myocardial infarction (19 %) vs. 229 with non-acute MI heart failure (81%), majority (69%) were SCAI C, and in-hospital mortality was 13%. Six cytokines, largely involved in the innate immune response were associated with in-hospital mortality in adjusted models, including higher levels of TNF-α, MIG/CXCL9, IL-8, IL-6, and IL-10 and lower levels of IFNα2 ( p< 0.05).
Conclusion: Excessive innate immune system activation at CS onset may be associated with in-hospital mortality. These findings warrant further investigation to identify pro-inflammatory pathways which may inform risk stratification and tailored therapies in CS.
