Circulating levels of miR-20b-5p are associated with survival in cardiogenic shock

Abstract

Cardiogenic shock (CS) is a medical emergency with high in-hospital mortality. New biomarkers are needed to identify patients at a greater risk of adverse outcomes. This study aimed to investigate the prognostic potential of microRNAs (miRNAs) in assessment of the outcome of cardiogenic shock. Circulating miRNA levels were measured by quantitative PCR in plasma samples collected at baseline from 165 patients of the multicenter, prospective, observational CardShock study and compared between in-hospital and 90-day survivors and non-survivors. Of the 10 studied miRNAs, median levels of miR-20b-5p at baseline were significantly higher in in-hospital and 90-day survivors compared to non-survivors [median 0.014 arbitrary units (AU) (interquartile range (IQR) 0.003-0.024) vs. 0.008 AU (IQR 0.001-0.015), p = 0.013] and [0.015 AU (IQR 0.003-0.025) vs. 0.010 AU (IQR 0.001-0.015), p = 0.012], respectively. In Cox regression analysis, miR-20b-5p levels in the highest quartile were significantly associated with 90-day survival (adjusted hazard ratio 2.47 (95 % confidence interval 1.16-5.28), p = 0.019) when adjusted for CardShock Risk Score variables (age, confusion at presentation, previous myocardial infarction or coronary artery bypass grafting, acute coronary syndrome (ACS) etiology, left ventricular ejection fraction, lactate, and estimated glomerular filtration rate). A similar association of highest quartile miR-20b-5p levels with 90-day survival was also confirmed in ACS patient subcohort (79 % of CS patients). The results of this study indicate that circulating levels of miR-20b-5p at baseline could help in assessing in-hospital and 90-day survival in CS patients.

Keywords: Biomarker; Cardiogenic shock; Survival; miR-20b-5p; microRNA.

Graphical abstract

Fig. 1

Circulating levels of miR-20b-5p at baseline. A and C in-hospital non-survivors and survivors; B and D 90-day non-survivors and survivors. All, All patients of the CardShock study cohort (in-hospital survival, n = 165; 90-day survival, n = 163, 2 patients lost during follow-up); ACS, Patients of the CardShock study cohort with acute coronary syndrome as etiology of cardiogenic shock (in-hospital survival, n = 131; 90-day survival, n = 129, 2 patients lost during follow-up); AU, arbitrary units; ^⁎, Mann-Whitney U test; the whiskers in box plots indicate calculated minimum and maximum values, above which value is considered as an outlier.

Fig. 2

Adjusted hazard ratios of circulating miR-20b-5p levels above 75th percentile at baseline. The CardShock risk score variables (age, confusion at presentation, previous myocardial infarction or coronary artery bypass grafting, acute coronary syndrome etiology, left ventricular ejection fraction, lactate, and estimated glomerular filtration rate) at baseline were used to adjust the hazard ratios of multivariable Cox regression analysis. All, All patients of the CardShock study cohort (n = 165); ACS, patients of the CardShock study cohort with acute coronary syndrome as etiology of cardiogenic shock (n = 131); AU, arbitrary units; MI, myocardial infarction; CABG, coronary artery bypass grafting; LVEF, left ventricular ejection fraction; eGFR, estimated glomerular filtration rate; HR, hazard ratio; CI, confidence interval.

Fig. 3

Kaplan-Meier survival curves of patients with circulating level of miR-20p-5p at baseline below and above median. (A) All patients of the CardShock cohort (n = 163) and (B) patients of the CardShock cohort with acute coronary syndrome (ACS) as an etiology of cardiogenic shock (n = 129). The differences in outcomes between patients with circulating level of miR-20p-5p at baseline below versus above median were compared using log rank test.