Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients with Suspected St-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

Martin Frydland, Sisse Rye Ostrowski, Jacob Eifer Møller, Edina Hadziselimovic, Lene Holmvang, Hanne Berg Ravn, Lisette Okkels Jensen, Anna Sina Pettersson, Jesper Kjaergaard, Matias Greve Lindholm, Pär Ingemar Johansson, Christian Hassager

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Mortality in ST-elevation myocardial infarction (STEMI) patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting endothelial damage would be associated with CS and mortality. Methods: In 96% of 1467 consecutive patients with suspected STEMI, biomarkers reflecting endothelial cell- (soluble thrombomodulin, sTM) and glycocalyx- (syndecan-1) damage were measured on admission. Patients were stratified by CS development or not. CS-Patients were substratified by CS on admission (admission-CS), CS developed in the catheterization laboratory (cath. lab.-CS), or late CS. Results: STEMI patients with admission-CS (n=85) and cath.lab.-CS (n=25) had higher levels of sTM and syndecan-1 compared with no-CS patients (n=1,299). Late CS-patients (n=58) had higher levels of sTM (median (25th; 75th percentile) 8.8 (7.0; 11.6) vs. 7.4 (6.0; 9.0) ng/mL, P=0.0004) but not Syndecan-1 (P=0.26) compared with no-CS patients. sTM was, however, not independently associated with late CS development (OR (95% CI) 1.07 (0.99-1.16), P=0.09). Patients with the highest level of sTM and syndecan-1 had the highest 30-day mortality (Plogrank<0.0001). However, neither sTM nor Syndecan-1 was independently associated with 30-day mortality (HR (95% CI) sTM: 1.06 (0.996-1.12), P=0.07; Syndecan-1: 1.04 (0.99-1.08), P=0.12). Conclusion: Patients with suspected STEMI patients and admission-CS/cath.lab.-CS had elevated admission levels of sTM and Syndecan-1comparedwith noCSpatients.Patients developing lateCShad higher sTMplasma concentrationcompared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.

Original languageEnglish
JournalShock
Volume50
Issue number5
Pages (from-to)538–544
ISSN1073-2322
DOIs
Publication statusPublished - Nov 2018

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Glycocalyx
Cardiogenic Shock
Thrombomodulin
Patient Admission

Keywords

  • Cardiogenic shock
  • ST-elevationmyocardial infarction
  • endothelium
  • mortality
  • syndecan-1
  • thrombomodulin

Cite this

Frydland, Martin ; Ostrowski, Sisse Rye ; Møller, Jacob Eifer ; Hadziselimovic, Edina ; Holmvang, Lene ; Ravn, Hanne Berg ; Jensen, Lisette Okkels ; Pettersson, Anna Sina ; Kjaergaard, Jesper ; Lindholm, Matias Greve ; Johansson, Pär Ingemar ; Hassager, Christian. / Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients with Suspected St-Elevation Myocardial Infarction Complicated by Cardiogenic Shock. In: Shock. 2018 ; Vol. 50, No. 5. pp. 538–544.
@article{7de938b4d6c247b6b9bd6c37e6140da4,
title = "Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients with Suspected St-Elevation Myocardial Infarction Complicated by Cardiogenic Shock",
abstract = "Background: Mortality in ST-elevation myocardial infarction (STEMI) patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting endothelial damage would be associated with CS and mortality. Methods: In 96{\%} of 1467 consecutive patients with suspected STEMI, biomarkers reflecting endothelial cell- (soluble thrombomodulin, sTM) and glycocalyx- (syndecan-1) damage were measured on admission. Patients were stratified by CS development or not. CS-Patients were substratified by CS on admission (admission-CS), CS developed in the catheterization laboratory (cath. lab.-CS), or late CS. Results: STEMI patients with admission-CS (n=85) and cath.lab.-CS (n=25) had higher levels of sTM and syndecan-1 compared with no-CS patients (n=1,299). Late CS-patients (n=58) had higher levels of sTM (median (25th; 75th percentile) 8.8 (7.0; 11.6) vs. 7.4 (6.0; 9.0) ng/mL, P=0.0004) but not Syndecan-1 (P=0.26) compared with no-CS patients. sTM was, however, not independently associated with late CS development (OR (95{\%} CI) 1.07 (0.99-1.16), P=0.09). Patients with the highest level of sTM and syndecan-1 had the highest 30-day mortality (Plogrank<0.0001). However, neither sTM nor Syndecan-1 was independently associated with 30-day mortality (HR (95{\%} CI) sTM: 1.06 (0.996-1.12), P=0.07; Syndecan-1: 1.04 (0.99-1.08), P=0.12). Conclusion: Patients with suspected STEMI patients and admission-CS/cath.lab.-CS had elevated admission levels of sTM and Syndecan-1comparedwith noCSpatients.Patients developing lateCShad higher sTMplasma concentrationcompared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.",
keywords = "Cardiogenic shock, ST-elevationmyocardial infarction, endothelium, mortality, syndecan-1, thrombomodulin",
author = "Martin Frydland and Ostrowski, {Sisse Rye} and M{\o}ller, {Jacob Eifer} and Edina Hadziselimovic and Lene Holmvang and Ravn, {Hanne Berg} and Jensen, {Lisette Okkels} and Pettersson, {Anna Sina} and Jesper Kjaergaard and Lindholm, {Matias Greve} and Johansson, {P{\"a}r Ingemar} and Christian Hassager",
year = "2018",
month = "11",
doi = "10.1097/SHK.0000000000001123",
language = "English",
volume = "50",
pages = "538–544",
journal = "Shock",
issn = "1073-2322",
publisher = "Lippincott Williams & Wilkins",
number = "5",

}

Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients with Suspected St-Elevation Myocardial Infarction Complicated by Cardiogenic Shock. / Frydland, Martin; Ostrowski, Sisse Rye; Møller, Jacob Eifer; Hadziselimovic, Edina; Holmvang, Lene; Ravn, Hanne Berg; Jensen, Lisette Okkels; Pettersson, Anna Sina; Kjaergaard, Jesper; Lindholm, Matias Greve; Johansson, Pär Ingemar; Hassager, Christian.

In: Shock, Vol. 50, No. 5, 11.2018, p. 538–544.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients with Suspected St-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

AU - Frydland, Martin

AU - Ostrowski, Sisse Rye

AU - Møller, Jacob Eifer

AU - Hadziselimovic, Edina

AU - Holmvang, Lene

AU - Ravn, Hanne Berg

AU - Jensen, Lisette Okkels

AU - Pettersson, Anna Sina

AU - Kjaergaard, Jesper

AU - Lindholm, Matias Greve

AU - Johansson, Pär Ingemar

AU - Hassager, Christian

PY - 2018/11

Y1 - 2018/11

N2 - Background: Mortality in ST-elevation myocardial infarction (STEMI) patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting endothelial damage would be associated with CS and mortality. Methods: In 96% of 1467 consecutive patients with suspected STEMI, biomarkers reflecting endothelial cell- (soluble thrombomodulin, sTM) and glycocalyx- (syndecan-1) damage were measured on admission. Patients were stratified by CS development or not. CS-Patients were substratified by CS on admission (admission-CS), CS developed in the catheterization laboratory (cath. lab.-CS), or late CS. Results: STEMI patients with admission-CS (n=85) and cath.lab.-CS (n=25) had higher levels of sTM and syndecan-1 compared with no-CS patients (n=1,299). Late CS-patients (n=58) had higher levels of sTM (median (25th; 75th percentile) 8.8 (7.0; 11.6) vs. 7.4 (6.0; 9.0) ng/mL, P=0.0004) but not Syndecan-1 (P=0.26) compared with no-CS patients. sTM was, however, not independently associated with late CS development (OR (95% CI) 1.07 (0.99-1.16), P=0.09). Patients with the highest level of sTM and syndecan-1 had the highest 30-day mortality (Plogrank<0.0001). However, neither sTM nor Syndecan-1 was independently associated with 30-day mortality (HR (95% CI) sTM: 1.06 (0.996-1.12), P=0.07; Syndecan-1: 1.04 (0.99-1.08), P=0.12). Conclusion: Patients with suspected STEMI patients and admission-CS/cath.lab.-CS had elevated admission levels of sTM and Syndecan-1comparedwith noCSpatients.Patients developing lateCShad higher sTMplasma concentrationcompared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.

AB - Background: Mortality in ST-elevation myocardial infarction (STEMI) patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting endothelial damage would be associated with CS and mortality. Methods: In 96% of 1467 consecutive patients with suspected STEMI, biomarkers reflecting endothelial cell- (soluble thrombomodulin, sTM) and glycocalyx- (syndecan-1) damage were measured on admission. Patients were stratified by CS development or not. CS-Patients were substratified by CS on admission (admission-CS), CS developed in the catheterization laboratory (cath. lab.-CS), or late CS. Results: STEMI patients with admission-CS (n=85) and cath.lab.-CS (n=25) had higher levels of sTM and syndecan-1 compared with no-CS patients (n=1,299). Late CS-patients (n=58) had higher levels of sTM (median (25th; 75th percentile) 8.8 (7.0; 11.6) vs. 7.4 (6.0; 9.0) ng/mL, P=0.0004) but not Syndecan-1 (P=0.26) compared with no-CS patients. sTM was, however, not independently associated with late CS development (OR (95% CI) 1.07 (0.99-1.16), P=0.09). Patients with the highest level of sTM and syndecan-1 had the highest 30-day mortality (Plogrank<0.0001). However, neither sTM nor Syndecan-1 was independently associated with 30-day mortality (HR (95% CI) sTM: 1.06 (0.996-1.12), P=0.07; Syndecan-1: 1.04 (0.99-1.08), P=0.12). Conclusion: Patients with suspected STEMI patients and admission-CS/cath.lab.-CS had elevated admission levels of sTM and Syndecan-1comparedwith noCSpatients.Patients developing lateCShad higher sTMplasma concentrationcompared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.

KW - Cardiogenic shock

KW - ST-elevationmyocardial infarction

KW - endothelium

KW - mortality

KW - syndecan-1

KW - thrombomodulin

U2 - 10.1097/SHK.0000000000001123

DO - 10.1097/SHK.0000000000001123

M3 - Journal article

C2 - 29438221

VL - 50

SP - 538

EP - 544

JO - Shock

JF - Shock

SN - 1073-2322

IS - 5

ER -