Clinical Characteristics, Management and Outcomes in Cardiogenic Shock: insights from a high-volume Italian Cardiac Intensive Care Unit

Abstract

Cardiogenic shock (CS) is a life-threatening condition. We aim to evaluate clinical characteristics, management and complication rate of patients with CS admitted in a high-volume hospital in Italy. We retrospectively reviewed the clinical, echocardiographic and laboratory data, therapeutic management and outcomes of patients with CS admitted to the Policlinico Gemelli (Rome) between January 1, 2020, and January 1, 2023. ​ We included 96 patients (median age 71 years, IQR 60-79; 65 [68%] males), of whom 49 patients (51%) presented CS secondary to acute myocardial infarction and 60 (63%) with a de-novo presentation of CS. Dobutamine was the most frequently used inotrope and noradrenaline the most frequently used vasopressor (adopted in 56% and 82% of cases respectively). Forty-five (47%) patients died during the hospitalization. Non-survivors were older, presented a higher inflammatory burden at admission, elevated lactate levels, a greater increase in lactate levels, higher left ventricular filling pressures and worse right ventricular function. C-Reactive Protein (CRP) levels [odd ratio (OR) 1.03, 95% confidence interval (CI) [1.00;1.04], p=0.027), lactate levels at admission (OR 3.49, 95% CI [1.59;7.63], p=0.02) and increase in lactate levels (OR 2.8, 95% CI [1.37;5.75], p=0.005) were independent predictors of in-hospital all cause death. Our data contribute to assess the regional variations in management and outcomes of patients with CS. We observed a high mortality and complication rate. Lactate acidosis and CRP measured at admission, may help in identifying patients at higher risk of adverse in-hospital outcomes.