Prognostic significance of haemodynamic parameters in patients with cardiogenic shock.
Prognostic significance of haemodynamic parameters in patients with cardiogenic shock.
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DOI：
10.1093/ehjacc/zuad095
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发表时间：
2023-10-25
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影响因子：
--
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中科院分区：
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使用肺动脉导管进行有创血流动力学评估通常用于指导心源性休克（CS）患者的管理，并可提供重要的预后信息。我们的目的是评估预后的关联和终末器官功能障碍的CS提出血流动力学参数的关系。重症监护心脏病学试验网络是由TIMI研究组协调的北美心脏重症监护病房（CICU）的多中心注册中心。纳入了在CICU入院后24小时内接受有创血流动力学评估的CS患者（2018-2022）。使用逻辑回归评估血液动力学参数与住院死亡率的关系，使用最小二乘均值回归评估与血清乳酸的关系。进行敏感性分析，排除暂时性机械循环支持的患者，并调整血管活性变力性评分。在3603例CS患者中，1473例在CICU入院后24小时内收集了血液动力学数据。中位心脏指数为1.9（第25 - 75百分位数，1.6-2.4）L/min/m2，平均动脉压（MAP）为74（66-86）mmHg。与死亡率相关的参数包括低MAP、低收缩压、低全身血管阻力、右心房压（RAP）升高、RAP/肺毛细血管楔压比升高和低肺动脉搏动指数。当控制背景药理学和机械血流动力学支持的强度时，这些相关性通常是一致的。这些参数也与较高的血清乳酸有关。在当代CS人群中，反映全身动脉张力降低和右心室功能障碍的血流动力学参数与不良结局和全身灌注不足相关。
Invasive haemodynamic assessment with a pulmonary artery catheter is often used to guide the management of patients with cardiogenic shock (CS) and may provide important prognostic information. We aimed to assess prognostic associations and relationships to end-organ dysfunction of presenting haemodynamic parameters in CS. The Critical Care Cardiology Trials Network is an investigator-initiated multicenter registry of cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Patients with CS (2018–2022) who underwent invasive haemodynamic assessment within 24 h of CICU admission were included. Associations of haemodynamic parameters with in-hospital mortality were assessed using logistic regression, and associations with presenting serum lactate were assessed using least squares means regression. Sensitivity analyses were performed excluding patients on temporary mechanical circulatory support and adjusted for vasoactive-inotropic score. Among the 3603 admissions with CS, 1473 had haemodynamic data collected within 24 h of CICU admission. The median cardiac index was 1.9 (25th–75th percentile, 1.6–2.4) L/min/m2 and mean arterial pressure (MAP) was 74 (66–86) mmHg. Parameters associated with mortality included low MAP, low systolic blood pressure, low systemic vascular resistance, elevated right atrial pressure (RAP), elevated RAP/pulmonary capillary wedge pressure ratio, and low pulmonary artery pulsatility index. These associations were generally consistent when controlling for the intensity of background pharmacologic and mechanical haemodynamic support. These parameters were also associated with higher presenting serum lactate. In a contemporary CS population, presenting haemodynamic parameters reflecting decreased systemic arterial tone and right ventricular dysfunction are associated with adverse outcomes and systemic hypoperfusion.
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影响因子：
4.1
作者：
Gaies, Michael G.;Gurney, James G.;Hirsch, Jennifer C.
通讯作者：
Hirsch, Jennifer C.
DOI：
10.1016/s0735-1097(03)00120-7
发表时间：
2003-04-16
影响因子：
24
作者：
Jacobs, AK;Leopold, JA;Hochman, JS
通讯作者：
Hochman, JS
影响因子：
24
作者：
Bohula, Erin A.;Katz, Jason N.;Vo, Chau
通讯作者：
Vo, Chau
影响因子：
18.2
作者：
Harjola, Veli-Pekka;Lassus, Johan;Mebazaa, Alexandre
通讯作者：
Mebazaa, Alexandre
影响因子：
37.8
作者：
van Diepen, Sean;Katz, Jason N.;Cohen, Mauricio G.
通讯作者：
Cohen, Mauricio G.