Mixed Shock Complicating Cardiogenic Shock: Frequency, Predictors, and Clinical Outcomes
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Published:2024-07
Issue:7
Volume:17
Page:
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ISSN:1941-3289
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Container-title:Circulation: Heart Failure
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language:en
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Short-container-title:Circ: Heart Failure
Author:
Baldetti Luca1ORCID, Gallone Guglielmo23ORCID, Filiberti Gaia1, Pescarmona Luca3, Cesari Andrea1ORCID, Rizza Vincenzo1ORCID, Roagna Edoardo23, Gurrieri Davide4ORCID, Peveri Beatrice1, Nocera Lorenzo23ORCID, Cianfanelli Lorenzo1ORCID, Marcelli Gianluca123, De Lio Giulia2, Boretto Paolo2ORCID, Angelini Filippo2ORCID, Gramegna MarioORCID, Pazzanese Vittorio1ORCID, Sacchi Stefania1, Calvo Francesco1, Ajello Silvia1, De Ferrari Gaetano Maria23, Frea Simone2ORCID, Scandroglio Anna Mara1
Affiliation:
1. Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.). 2. Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy (G.G., E.R., L.N., G.M., G.D.L., P.B., F.A., G.M.D.F., S.F.). 3. Department of Medical Sciences, University of Turin, Italy (G.G., L.P., E.R., L.N., G.M., G.M.D.F.). 4. Mathematics Department, Polytechnic University of Milan, Italy (D.G.).
Abstract
BACKGROUND:
Patients presenting with cardiogenic shock (CS) are at risk of developing mixed shock (MS), characterized by distributive-inflammatory phenotype. However, no objective definition exists for this clinical entity.
METHODS:
We assessed the frequency, predictors, and prognostic relevance of MS complicating CS, based on a newly proposed objective definition. MS complicating CS was defined as an objective shock state secondary to both an ongoing cardiogenic cause and a distributive-inflammatory phenotype arising at least 12 hours after the initial CS diagnosis, as substantiated by predefined longitudinal changes in hemodynamics, clinical, and laboratory parameters.
RESULTS:
Among 213 consecutive patients admitted at 2 cardiac intensive care units with CS, 13 with inflammatory-distributive features at initial presentation were excluded, leading to a cohort of 200 patients hospitalized with pure CS (67±13 years, 96% Society of Cardiovascular Angiography and Interventions CS stage class C or higher). MS complicating CS occurred in 24.5% after 120 (29–216) hours from CS diagnosis. Lower systolic arterial pressure (
P
=0.043), hepatic injury (
P
=0.049), and suspected/definite infection (
P
=0.013) at CS diagnosis were independent predictors of MS development. In-hospital mortality (53.1% versus 27.8%;
P
=0.002) and hospital stay (21 [13–48] versus 17 [9–27] days;
P
=0.018) were higher in the MS cohort. At logistic multivariable analysis, MS diagnosis (odds ratio [OR], 3.00 [95% CI, 1.39–6.63];
P
adj
=0.006), age (OR, 1.06 [95% CI, 1.03–1.10] years;
P
adj
<0.001), admission systolic arterial pressure <100 mm Hg (OR, 2.41 [95% CI, 1.19–4.98];
P
adj
=0.016), and admission serum creatinine (OR, 1.61 [95% CI, 1.19–2.26];
P
adj
=0.003) conferred higher odds of in-hospital death, while early temporary mechanical circulatory support was associated with lower in-hospital death (OR, 0.36 [95% CI, 0.17–0.75];
P
adj
=0.008).
CONCLUSIONS:
MS complicating CS, objectively defined leveraging on longitudinal changes in distributive and inflammatory features, occurs in one-fourth of patients with CS, is predicted by markers of CS severity and inflammation at CS diagnosis, and portends higher hospital mortality.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Cited by
1 articles.
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