Inflammation in cardiogenic shock: a marker of outcome, not yet a treatment target

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ID: 332845
2026
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Abstract
This editorial refers to ‘Associations between admission C-reactive protein and in-hospital mortality amongst patients with cardiogenic shock’ by S. Mendelsohn et al., published in this issue. Therapeutic options in cardiogenic shock remain largely limited. Over the past two decades, the field has refined haemodynamic staging, and the SCAI classification now describes the severity of a patient's condition with reasonable precision.1 It, however, does not provide prognostic value; we would need to understand why two patients at the same stage can follow different courses. Mendelsohn et al.,2 in this issue of the journal, examine one candidate explanation, systemic inflammation, using the most widely available biomarker in routine practice.2 The study builds on the Vizient Clinical Data Base and identifies 26 525 adults with a discharge code for cardiogenic shock, a C-reactive protein (CRP) measurement within 2 days of admission, and no coded sepsis. In-hospital mortality rose from 28.7% in the lowest CRP tertile to 42.3% in the highest. After inverse probability weighting, the absolute excess mortality was 3.9% in the middle tertile and 12.4% in the top tertile. The gradient persisted when CRP was restricted to day one, when the cohort was split by heart failure or myocardial infarction as the admission diagnosis, and within C and D stages of the SCAI. Each 50 mg/L increase in CRP was associated with a 19% increase in mortality.
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Authors Tomasz J Guzik
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Journal European Heart Journal Acute Cardiovascular Care
Year 2026
DOI
10.1093/ehjacc/zuag124
URL
https://doi.org/10.1093/ehjacc/zuag124
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