Predictors of in-hospital mortality among cardiogenic shock patients. Prognostic and therapeutic implications

• Published in: International journal of cardiology 2016-12, Vol.224, p.114-118
• Main Authors: Li, Xin, Sousa-Casasnovas, Iago, Devesa, Carolina, Juárez, Miriam, Fernández-Avilés, Francisco, Martínez-Sellés, Manuel
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Assisted Circulation - instrumentation; Assisted Circulation - methods; Assisted Circulation - statistics & numerical data; Cardiogenic shock; Cardiovascular; Disease Management; Female; Heart-Assist Devices; Hospital Mortality; Humans; INTERMACS; Male; Management; Middle Aged; Outcome and Process Assessment (Health Care); Prognosis; Risk Assessment - methods; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Spain - epidemiology; Survival Analysis; Time Factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.09.019

Abstract Background Cardiogenic shock (CS) has a poor prognosis. The heterogeneity in the mortality through different subgroups suggests that some factors can be useful to perform risk stratification and guide management. We aimed to find predictors of in-hospital mortality in these patients. Methods We analysed all cases of cardiogenic shock due to medical conditions admitted in our intensive acute cardiovascular care unity from November 2010 till November 2015. Clinical, biochemical and hemodynamic variables were registered, as was the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile at 24h of CS diagnosis. From a total of 281 patients, 28 died within the first 24 hours and were not included in the analysis. Results A total of 253 patients survived the first 24 hours, mean age was 68.8 ± 14.4 years, and 174 (68.8%) were men. Aetiologies: acute coronary syndrome 146 (57.7%), acute heart failure 60 (23.7%), arrhythmias 35 (13.8%), and others 12 (4.8%). A total of 91 patients (36.0%) died during hospitalization. We found the following independent predictors of in-hospital mortality: age (odds ratio [OR] 1.032, 95% confidence interval [CI] 1.003-1.062), blood glucose (OR 1.004, 95% CI 1.001-1.008), heart rate (OR 1.014, 95% CI 1.001-1.028), and INTERMACS profile (OR 0.168, 95% CI 0.107-0.266]). Conclusions In patients with CS the INTERMACS profile at 24 hours of diagnosis was associated with higher in-hospital mortality. This and other prognostic variables (age, blood glucose, and heart rate) may be useful for risk stratification and to select appropriate medical or invasive interventions.