Mixed Shock Complicating Cardiogenic Shock: Frequency, Predictors, and Clinical Outcomes.

IF 7.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2024-07-01 Epub Date: 2024-07-09 DOI:10.1161/CIRCHEARTFAILURE.123.011404

Luca Baldetti, Guglielmo Gallone, Gaia Filiberti, Luca Pescarmona, Andrea Cesari, Vincenzo Rizza, Edoardo Roagna, Davide Gurrieri, Beatrice Peveri, Lorenzo Nocera, Lorenzo Cianfanelli, Gianluca Marcelli, Giulia De Lio, Paolo Boretto, Filippo Angelini, Mario Gramegna, Vittorio Pazzanese, Stefania Sacchi, Francesco Calvo, Silvia Ajello, Gaetano Maria De Ferrari, Simone Frea, Anna Mara Scandroglio

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引用次数: 0

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.

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混合性休克并发心源性休克：频率、预测因素和临床结果。

背景：出现心源性休克（CS）的患者有发展为混合性休克（MS）的风险，混合性休克以分布性炎表型为特征。然而，对这一临床实体尚无客观定义：我们根据新提出的客观定义评估了 CS 并发 MS 的频率、预测因素和预后相关性。CS并发MS被定义为在初次CS诊断后至少12小时出现的继发于持续心源性病因和分布性炎症表型的客观休克状态，并通过预先确定的血液动力学、临床和实验室参数的纵向变化加以证实：在 2 个心脏重症监护病房连续收治的 213 名 CS 患者中，有 13 名患者在初次发病时具有炎症分布特征，但被排除在外，因此有 200 名单纯 CS 住院患者（67±13 岁，96% 为心血管血管造影和介入学会 CS 分期 C 级或更高）。24.5%的患者在确诊CS120（29-216）小时后发生CS并发症。CS诊断时较低的收缩动脉压（P=0.043）、肝损伤（P=0.049）和疑似/无限期感染（P=0.013）是MS发生的独立预测因素。MS队列的院内死亡率（53.1%对27.8%；P=0.002）和住院时间（21 [13-48] 天对17 [9-27] 天；P=0.018）均较高。在逻辑多变量分析中，MS诊断（几率比[OR]，3.00 [95% CI，1.39-6.63]；Padj=0.006）、年龄（OR，1.06 [95% CI，1.03-1.10]岁；PadjPadj=0.016）和入院血清肌酐（OR，1.61 [95% CI，1.19-2.26]；Padj=0.003）会导致较高的院内死亡几率，而早期临时机械循环支持与较低的院内死亡相关（OR，0.36 [95% CI，0.17-0.75]；Padj=0.008）：根据分布和炎症特征的纵向变化客观定义的CS并发多发性硬化症发生在四分之一的CS患者中，可通过CS诊断时的CS严重程度和炎症指标预测，并预示着较高的住院死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.