The CS4P protein classifier combined with the CardShock risk score improved 90-day mortality risk prediction compared to the CardShock score alone (C-statistic 0.84 vs 0.78; P=0.033).
Observational (n=145)
Does the CS4P protein-based score improve 90-day mortality risk prediction compared to clinical risk scores alone in patients with cardiogenic shock?
A novel 4-protein biomarker panel (CS4P) significantly improves 90-day mortality risk stratification when added to contemporary clinical risk scores in patients with cardiogenic shock.
Effect estimate: C-statistic
Absolute Event Rate: 0.84% vs 0.78%
p-value: p=0.033
AIMS: Cardiogenic shock (CS) is associated with high short-term mortality and a precise CS risk stratification could guide interventions to improve patient outcome. Here, we developed a circulating protein-based score to predict short-term mortality risk among patients with CS. METHODS AND RESULTS: Mass spectrometry analysis of 2654 proteins was used for screening in the Barcelona discovery cohort (n = 48). Targeted quantitative proteomics analyses (n = 51 proteins) were used in the independent CardShock cohort (n = 97) to derive and cross-validate the protein classifier. The combination of four circulating proteins (Cardiogenic Shock 4 proteins-CS4P), discriminated patients with low and high 90-day risk of mortality. CS4P comprises the abundances of liver-type fatty acid-binding protein, beta-2-microglobulin, fructose-bisphosphate aldolase B, and SerpinG1. Within the CardShock cohort used for internal validation, the C-statistic was 0.78 for the CardShock risk score, 0.83 for the CS4P model, and 0.84 (P = 0.033 vs. CardShock risk score) for the combination of CardShock risk score with the CS4P model. The CardShock risk score with the CS4P model showed a marked benefit in patient reclassification, with a net reclassification improvement (NRI) of 0.49 (P = 0.020) compared with CardShock risk score. Similar reclassification metrics were observed in the IABP-SHOCK II risk score combined with CS4P (NRI =0.57; P = 0.032). The CS4P patient classification power was confirmed by enzyme-linked immunosorbent assay (ELISA). CONCLUSION: A new protein-based CS patient classifier, the CS4P, was developed for short-term mortality risk stratification. CS4P improved predictive metrics in combination with contemporary risk scores, which may guide clinicians in selecting patients for advanced therapies.
Rueda et al. (Sat,) conducted a observational in Cardiogenic shock (n=145). CS4P (Cardiogenic Shock 4 proteins) classifier vs. CardShock risk score was evaluated on 90-day mortality risk prediction (C-statistic, p=0.033). The CS4P protein classifier combined with the CardShock risk score improved 90-day mortality risk prediction compared to the CardShock score alone (C-statistic 0.84 vs 0.78; P=0.033).
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