The novel cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide (CLIP)-based mortality risk score in cardiogenic shock after acute myocardial infarction

Abstract Background Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) still reaches excessively high mortality rates. This analysis is aimed to develop a new easily applicable biomarker-based risk score. Methods and results A score for 30-day was developed from 458 patients with CS AMI included in the randomized CULPRIT-SHOCK trial. The selection of relevant predictors coefficient estimation prognostic model were performed by penalized multivariate logistic regression analysis. Validation internally, internally externally as well 163 IABP-SHOCK II Blood samples obtained at randomization. two trials are registered ClinicalTrials.gov (NCT01927549 NCT00491036), closed participants, follow-up completed. Out 58 candidate variables, four strongest CLIP (cystatin C, lactate, interleukin-6, N-terminal pro-B-type natriuretic peptide). calibrated yielded c-statistics 0.82 [95% confidence interval (CI) 0.78–0.86] internal validation, (95% CI 0.75–0.89) internal-external (temporal) 0.73 0.65–0.81) external validation. Notably, it outperformed Simplified Acute Physiology Score prognostication (0.83 vs 0.62; P < 0.001 0.83 vs. 0.76; = 0.03, respectively). Conclusions biomarker-only stratification infarct-related developed, extensively validated prospective cohort contemporary after AMI. other clinical scores may be useful an early decision tool CS.