Clinical picture and risk prediction of short-term mortality in cardiogenic shock
Clinical picture and risk prediction of short-term mortality in cardiogenic shock
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DOI：
10.1002/ejhf.260
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发表时间：
2015-05-01
影响因子：
18.2
通讯作者：
Mebazaa, Alexandre
中科院分区：
文献类型：
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作者：
Harjola, Veli-Pekka;Lassus, Johan;Mebazaa, Alexandre
目的研究心源性休克的临床表现和预后，并建立短期死亡率的风险预测评分。方法和结果CardShock研究是一项在2010-2012年间进行的多中心前瞻性观察性研究。有急性冠脉综合征或非急性冠脉综合征病因的患者在检测到心源性休克后6h内入选(n=219，平均年龄67岁，男性74%)。心源性休克定义为严重低血压，临床体征为低灌流和/或尽管液体复苏，但血乳酸和/或血乳酸/GT；2 mmol/L。比较不同休克病因的临床表现、处理和生化指标的数据。平均收缩压为78 mm Hg(标准差14 mm Hg)，平均动脉压为57 mm Hg(11 Mm Hg)。最常见的原因(81%)是急性冠脉综合征(68%的ST段抬高心肌梗死和8%的机械并发症)；94%的人接受了冠状动脉造影术，其中89%的人接受了经皮冠状动脉介入治疗。非急性冠脉综合征的主要病因是严重的慢性心力衰竭和瓣膜原因。住院死亡率为37%(n=80)。冠脉综合征的病因学、年龄、既往心肌梗死史、冠状动脉搭桥术史、精神错乱、低左室射血分数和血乳酸水平与死亡率的增加独立相关。包括这些变量的CardShock风险评分和估计的肾小球滤过率可以很好地预测住院死亡率(曲线下面积0.85)。结论尽管最常见的原因是急性冠脉综合征，但其他原因占休克病例的五分之一。急性冠脉综合征与住院死亡率独立相关。CardShock风险评分由七个常见变量组成，很容易对短期死亡风险进行分层。它可能有助于重症监护的早期决策或在临床试验中指导患者选择。
AimsThe aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality.Methods and resultsThe CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85).ConclusionAlthough most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials.Trial registrationNCT01374867.