Key result
The CS4P protein classifier combined with the CardShock risk score improved 90-day mortality risk prediction compared to the CardShock score alone.
Why the study?
Cardiogenic shock carries high short-term mortality, and precise risk stratification could guide interventions to improve patient outcomes.
Does the CS4P protein-based score improve 90-day mortality risk prediction compared to clinical risk scores alone in patients with cardiogenic shock?
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.
Answers are grounded in this paper and cite their sources.
May refine cardiogenic shock risk stratification; hypothesis-generating and requires prospective validation before practice change.
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.
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Rueda et al. (2019) conducted an 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.
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