Prevalence and Clinical Outcomes of Acute Noncardiac Organ Failure among Non-Acute Myocardial Infarction Cardiogenic Shock: A Nationwide Cohort Analysis

Abstract

AbstractBackgroundNoncardiac organ failure often complicates cardiogenic shock (CS). The results of cardiogenic shock caused by noncardiac organ failures in patients without acute myocardial infarction (AMI) are not well documented.MethodsWe examined the National Inpatient Sample (NIS) data from 2016 to 2020 to identify cases of CS and non-AMI CS-related hospitalizations. We divided both cohorts based on the number of acute noncardiac organ failures and evaluated the influence of organ failure on the primary outcome, which was in-hospital mortality.ResultsA total of 599,210 (100%) cardiogenic shock and 366,905 (61.2%) non-AMI CS hospitalizations were identified. Among those with non-AMI CS, 58,965 (16.07%) had no organ failure, 121,845 (33.21%) had a single organ failure, and 186,095 (50.72%) had a multiorgan failure. Acute Kidney Injury (AKI) was the most common non-cardiac organ failure (38.1%). Multiorgan failure was associated with an increased risk of in-hospital mortality (aOR: 4.91, 95% CI: 4.72-5.06, p <0.001) compared to no organ failure. A notable increase in mortality rates was observed in correlation with the number of organ involvement. The highest mortality rates were seen in cases where five or more organs were affected. Neurological failure exhibited a significant association with mortality when compared to other organ failures. Similar trends were seen among the CS cohort.ConclusionsIn non-acute myocardial infarction and all cardiogenic shock patients, AKI is the most common type of organ failure, and neurological failure was associated with the highest mortality rate. The presence of noncardiac multiorgan failure was found to be strongly associated with a higher mortality rate. This risk increased as more organs were affected.Clinical PerspectiveWhat Is New?● Non-AMI patients bear a considerable load of non-cardiac organ failure, where AKI is the most prevalent form of organ failure. Additionally, neurological failure has the highest in-hospital mortality rate.● A predictor model for calculating the probability of in-hospital mortality in all CS patients.● Non-AMI cardiogenic shock and all cardiogenic shock patients are associated with higher morbidity, mortality, and resource utilization, as well as advanced circulatory support therapies, which increase as the number of affected organs increases.What are the Clinical Implications?● Multi-organ failure in non-AMI CS can have worse cardiovascular outcomes.● A multidisciplinary team’s involvement in managing these complex CS patients should be considered.