Prognostic performance of serial determination of the Society for Cardiovascular Angiography and Interventions Shock Classification in adults with critical illness

Abstract

Abstract Purpose To evaluate whether serial assessment of shock severity can improve prognostication in intensive care unit (ICU) patients. Materials and Methods Retrospective cohort of 21,461 ICU patient admissions from 2014 to 2018. We assigned the Society for Cardiovascular Angiography and Interventions (SCAI) Shock Stage in each 4-hour block during the first 24 hours of ICU admission; shock was defined as SCAI Shock Stage C, D, or E. In-hospital mortality was evaluated using logistic regression. Results The admission SCAI Shock Stage was: A, 39.0%; B, 27.0%; C, 28.9%; D, 2.6%; E, 2.5%. SCAI Shock Stage subsequently increased in 30.6%, and late-onset shock developed in 30.4%. In-hospital mortality was higher in patients who had shock on admission (11.9%) or late-onset shock (7.3%) versus no shock (4.3%). Persistence of shock predicted higher mortality (adjusted OR 1.09 [95% CI 1.06-1.13] for each ICU block with shock). The mean SCAI Shock Stage had higher discrimination for in-hospital mortality than the admission or maximum SCAI Shock Stage. Dynamic modeling of the SCAI Shock Classification improved discrimination for in-hospital mortality (C-statistic 0.64 to 0.71). Conclusions Serial application of the SCAI shock classification provides improved mortality risk stratification compared to a single assessment on admission, facilitating dynamic prognostication.