High Circulating Dipeptidyl Peptidase 3 Predicts Mortality and Need for Organ Support in Cardiogenic Shock: An Ancillary Analysis of the ACCOST-HH Trial

• Published in: Journal of cardiac failure
• Main Authors: PICOD, ADRIEN, NORDIN, HUGO, JARCZAK, DOMINIK, ZELLER, TANJA, ODDOS, CLAIRE, SANTOS, KARINE, HARTMANN, OLIVER, HERPAIN, ANTOINE, MEBAZAA, ALEXANDRE, KLUGE, STEFAN, AZIBANI, FERIEL, KARAKAS, MAHIR
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 30-04-2024
• Subjects: Cardiogenic shock; circulatory failure; dipeptidyl peptidase 3; Cardiogenic shock; circulatory failure; dipeptidyl peptidase 3
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2024.03.014

•Circulating dipeptidyl peptidase 3 (cDPP3) is a novel biomarker under investigation during circulatory failure.•In a large and diverse population of cardiogenic shock patients, high initial cDPP3 was associated with higher 30-day mortality, fewer days alive without cardiovascular support, and a greater need for renal replacement therapy and mechanical ventilation.•Although patients with a sustained high cDPP3 had a very poor prognosis, patients with initially high but decreasing cDPP3 at 72 hours had a markedly lower 30-day mortality, comparable with patients with a sustained low cDPP3.
Cardiogenic shock (CS) is burdened with high mortality. Efforts to improve outcome are hampered by the difficulty of individual risk stratification and the lack of targetable pathways. Previous studies demonstrated that elevated circulating dipeptidyl peptidase 3 (cDPP3) is an early predictor of short-term outcome in CS, mostly of ischemic origin. Our objective was to investigate the association between cDPP3 and short-term outcomes in a diverse population of patients with CS.
cDPP3 was measured at baseline and after 72 hours in the AdreCizumab against plaCebO in SubjecTs witH cardiogenic sHock (ACCOST-HH) trial. The association of cDPP3 with 30-day mortality and need for organ support was assessed. Median cDPP3 concentration at baseline was 43.2 ng/mL (95% confidence interval [CI], 21.2–74.0 ng/mL) and 77 of the 150 patients (52%) had high cDPP3 over the predefined cutoff of 40 ng/mL. Elevated cDPP3 was associated with higher 30-day mortality (adjusted hazard ratio [aHR] = 1.7; 95% CI, 1.0–2.9), fewer days alive without cardiovascular support (aHR, 3 days [95% CI, 0–24 days] vs aHR, 21 days [95% CI, 5–26 days]; P < .0001) and a greater need for renal replacement therapy (56% vs 22%; P < .0001) and mechanical ventilation (90 vs 74%; P = .04). Patients with a sustained high cDPP3 had a poor prognosis (reference group). In contrast, patients with an initially high but decreasing cDPP3 at 72 hours had markedly lower 30-day mortality (aHR, 0.17; 95% CI, 0.084–0.34), comparable with patients with a sustained low cDPP3 (aHR, 0.23; 95% CI, 0.12–0.41). The need for organ support was markedly decreased in subpopulations with sustained low or decreasing cDPP3.
The present study confirms the prognostic value of cDPP3 in a contemporary population of patients with CS.
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