Decoding cardiogenic shock: assessing shock index and its variants as prognostic indicators for in-hospital mortality.

Autor: Colarusso L; Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy., Brahmbhatt DH; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Scolari FL; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Keon KA; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Shin E; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., De Pellegrin Overgaard AI; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Nisar M; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Fung N; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Ibrahimova N; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Billia F; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Overgaard CB; Southlake Regional Health Centre, Newmarket, ON, Canada., Luk AC; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2024 Jun 06. Date of Electronic Publication: 2024 Jun 06.
DOI: 10.1002/ehf2.14853
Abstrakt: Background: Cardiogenic shock (CS) is associated with high in-hospital mortality. Objective assessment of its severity and prognosis is paramount for timely therapeutic interventions. This study aimed to evaluate the efficacy of the shock index (SI) and its variants as prognostic indicators for in-hospital mortality.
Methods: A retrospective study involving 1282 CS patients were evaluated. Baseline patient characteristics, clinical trajectory, hospital outcomes, and shock indices were collected and analysed. Receiver operating characteristic (ROC) curves were employed to determine the predictive accuracy of shock indices in predicting in-hospital mortality.
Results: Of those evaluated, 866 (67.6%) survived until discharge. Non-survivors were older (66.0 ± 13.7 vs. 57.4 ± 16.2, P < 0.001), had a higher incidence of cardiac risk factors, and were more likely to present with acute coronary syndrome (33.4% vs. 16.1%, P < 0.001) and out-of-hospital cardiac arrest (11.3% vs. 5.3%, P < 0.001). All mean shock indices were significantly higher in non-survivors compared with survivors. ROC curves demonstrated that adjusted shock index (ASI), age-modified shock index (AMSI), and shock index-C (SIC) had the highest predictive accuracy for in-hospital mortality, with AUC values of 0.654, 0.667, and 0.659, respectively. Subgroup analysis revealed that SIC had good predictive ability in patients with STEMI (AUC: 0.714) and ACS (AUC: 0.696) while AMSI and ASI were notably predictive in the OHCA group (AUC: 0.707 and 0.701, respectively).
Conclusions: Shock index and its variants, especially ASI, AMSI, and SIC, may be helpful in predicting in-hospital mortality in CS patients. Their application could guide clinicians in upfront risk stratification. SIC, ASI, and AMSI show potential in predicting in-hospital mortality in specific CS subsets (STEMI and OHCA). This is the first study to evaluate SI and its variants in CS patients.
(© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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