Altered mental status predicts mortality in cardiogenic shock – results from the CardShock study

Abstract

Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.

Impact of delirium on patients hospitalized for myocardial infarction: A propensity score analysis of the National Inpatient Sample

“…After adjustment for several confounders, the risk of death was still higher in the delirium group (Table ). This association has been well reported in the general medical setting and extended to other settings of care, including the ICU and skilled nursing facilities . Although a few studies showed no association with increased mortality, these were mostly single‐center studies with small sample sizes and examined a different subset of patients .…”

“…To the best of our best knowledge, this is the largest study that examined the association of delirium with worse in‐hospital clinical outcomes in patients with MI. Previous studies examined the impact of delirium in limited populations, including those with cardiogenic shock, in the cardiac ICU, undergoing transcatheter aortic valve replacement, or CABG, with an emphasis on elderly populations . The analysis used the strength of the NIS, with large sample sizes and the ability to adjust for several confounding variables.…”

“…This association has been well reported in the general medical setting and extended to other settings of care, including the ICU and skilled nursing facilities. [17][18][19][20][21][22] Although a few studies showed no association with increased mortality, these were mostly single-center studies with small sample sizes and examined a different subset of patients. 23,24 A meta-analysis of studies examining mortality associated with delirium in critical care settings showed that delirium was associated with increased mortality and longer hospital stay.…”

“…Previous studies examined the impact of delirium in limited populations, including those with cardiogenic shock, in the cardiac ICU, undergoing transcatheter aortic valve replacement, or CABG, with an emphasis on elderly populations. 16,18,[30][31][32] The analysis used the strength of the NIS, with large sample sizes and the ability to adjust for several confounding variables. We used 2 widely used methods, multivariable logistic regression and propensity score matching analysis, to adjust for confounding variables that affect both the outcome and the presence of the delirium.…”

Hypoperfusionssyndrom und kardiogener Schock

“…Dazu gehören kalte, feuchte Extremitäten ("kaltschweißig"), aber auch veränderter mentaler Status. In der CardShock-Studie waren diese Patienten charakterisiert durch niedrigeren pH-Wert und höheres Laktat; sie hatten eine deutlich erhöhte Mortalität (51 vs. 22 % 90-Tage-Mortalität, p < 0,001) [5].…”