Abstract 4366421: Admission Cell-free DNA Predicts Cardiogenic Shock Progression and In-Hospital Mortality

Introduction: Identifying high-risk patients in cardiogenic shock (CS) has been limited by the sparse availability of biomarkers that can assist early-risk stratification. Given its ability to identify cellular injury and death, cell-free DNA (cfDNA) may offer prognostic value in identifying patients at risk for worsening shock state and death. Methods: In a prospective single-center study, plasma nuclear cfDNA (ncfDNA) was measured at hospital admission using digital droplet PCR. Associations with SCAI Shock Stage progression and in-hospital mortality were analyzed using non-parametric tests, logistic regression, and ROC curves. Results: Among 225 CS patients (median age 58 years), 35% (N=76) of patients progressed to a worse SCAI Stage and 23% (N=49) experienced mortality during hospitalization. Admission ncfDNA levels were almost double in those who developed worsening CS (42,039 vs 27,491 copies/mL, p 0.009), and ncfDNA strongly correlated with patients’ worst SCAI Shock Stages (ordinal regression OR 3.1 [95% CI 1.9-5.1, p<0.0001]). Each log increase in ncfDNA was associated with higher odds of suffering from in-hospital mortality (OR 3.5, 95% CI 1.9–6.9, p=0.002). ROC analysis showed ncfDNA outperformed clinical scores including SCAI, VIS, and SOFA in predicting in-hospital mortality (AUC 0.765; Fig). Conclusions: Admission ncfDNA levels are associated with CS progression and mortality, supporting its potential role in early risk stratification. External validation with an independent cohort is warranted to confirm cfDNA’s role in early risk-stratification.