Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Jentzer, Jacob C.; Wiley, Brandon M.; Bennett, Courtney; Murphree, Dennis H.; Keegan, Mark T.; Gajic, Ognjen; Kashani, Kianoush; Barsness, Gregory W.

doi:10.1002/clc.23339

Cited by 23 publications

(45 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We retrospectively analysed a previously constructed database including data from the index CICU admission of consecutive unique adult patients aged ≥18 years admitted to the CICU at Mayo Clinic Hospital, St. Mary's Campus between 1 January 2007, and 31 December 2015. 1, [4][5][6]17,18,[20][21][22][23][24][25][26] To minimize bias associated with CICU readmission, only data from the first CICU admission during the study period were analysed.…”

Section: Study Populationmentioning

confidence: 99%

“…21 The Acute Physiology and Chronic Health Evaluation (APACHE) III score, APACHE IV predicted hospital mortality, and SOFA scores were automatically calculated using data from the first 24 h of CICU admission using previously validated electronic algorithms. 1, 4,20,21,25 The non-cardiovascular SOFA score was calculated by summing the other five SOFA organ sub-scores. 4,25 Individual co-morbidities used to calculate the Charlson Co-morbidity Index were extracted from the medical record using a previously validated electronic algorithm.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Using the Multidisciplinary Epidemiology and Translational Research in Intensive Care Data Mart, we recorded demographic, vital signs, laboratory, clinical, and outcome data, as well as procedures and therapies performed during the CICU and hospital stay. 1, [4][5][6]17,18,[20][21][22][23][24][25][26][27] The admission vital signs, clinical measurements, and laboratory values were defined as either the first value recorded after or closest to the index CICU admission. Vital signs were recorded every 15 min during the first hour after CICU admission.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Admission diagnoses were defined as all International Classification of Diseases-9 diagnostic codes within 1 day before or after CICU admission; admission diagnoses were not mutually-exclusive. 5,6,18,21 Maximum vasopressor and inotrope doses during the CICU stay were quantified using the peak vasoactive-inotropic score. 22 Non-cardiovascular organ failure was defined as a score ≥3 on any of the non-cardiovascular Sequential Organ Failure Assessment (SOFA) organ sub-scores on CICU Day 1.…”

Section: Data Sourcesmentioning

confidence: 99%

See 3 more Smart Citations

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

et al. 2020

Self Cite

View full text Add to dashboard Cite

Aims Age is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in-hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF. Methods and results We retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007-2015 and stratified patients by age and SCAI shock stage. The association between age and in-hospital mortality was analysed using multivariable logistic regression, and 1 year mortality was analysed using Cox proportional hazards analysis, both in the entire cohort and among patients with an admission diagnosis of HF or acute coronary syndrome (ACS). The final study population included 10 004 unique patients with a mean age of 67 ± 15 years, including 46.1% with HF and 43.1% with ACS. Older patients more frequently had HF and had more extensive co-morbidities, higher illness severity, more organ failure, and differential use of critical care therapies. The percentage of patients with SCAI shock stages A, B, C, D, and E were 46%, 30%, 16%, 7%, and 1%, respectively. Patients with HF were older, had greater severity of illness and higher SCAI shock stage, and had higher rates of death at all time points. In-hospital mortality occurred in 908 (9%) patients, including 549 (12%) patients with HF (61% of all hospital deaths). Age was independently associated with hospital mortality (adjusted odds ratio per 10 years 1.3, 95% confidence interval 1.2-1.4, P < 0.001) and 1 year mortality (adjusted hazard ratio per 10 years 1.2, 95% confidence interval 1.2-1.3, P < 0.001) in the overall cohort. The associations of age with both hospital mortality (adjusted odds ratio 1.6 vs. 1.3 per 10 years older) and 1 year mortality (adjusted hazard ratio 1.5 vs. 1.3 per 10 years older) were higher for patients with ACS compared with patients with HF. Older age was associated with higher adjusted hospital mortality and 1 year mortality in each SCAI shock stage (all P < 0.05). Additive increases in both hospital mortality and 1 year mortality were observed with increasing age and SCAI shock stage. Conclusions Age is an independent risk factor for mortality that modifies the relationship between the SCAI shock stage and mortality risk in CICU patients, providing robust risk stratification for in-hospital and 1 year mortality. Although patients with HF had a higher risk of dying, age was more strongly associated with mortality among patients with ACS.

show abstract

Section: Study Populationmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

See 2 more Smart Citations

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Baseline creatinine was considered to be the latest creatinine within 1 year prior to the index hospital admission, and patients who had previously received dialysis were excluded from this AKI analysis. Non-cardiovascular organ failure was defined as a score ≥ 3 on any day 1 SOFA organ subscore [16].…”

Section: Data Sourcesmentioning

confidence: 99%

Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: The optimal MAP target for patients with cardiogenic shock (CS) remains unknown. We sought to determine the relationship between mean arterial pressure (MAP) and mortality in the cardiac intensive care unit (CICU) patients with CS. Methods: Using a single-center database of CICU patients admitted between 2007 and 2015, we identified patients with an admission diagnosis of CS. MAP was measured every 15 min, and the mean of all MAP values during the first 24 h (mMAP 24) was recorded. Multivariable logistic regression determined the relationship between mMAP 24 and adjusted hospital mortality. Results: We included 1002 patients with a mean age of 68 ± 13.7 years, including 36% females. Admission diagnoses included acute coronary syndrome in 60%, heart failure in 74%, and cardiac arrest in 38%. Vasoactive drugs were used in 72%. The mMAP 24 was higher (75 vs. 71 mmHg, p < 0.001) among hospital survivors (66%) compared with non-survivors (34%). Hospital mortality was inversely associated with mMAP 24 (adjusted OR 0.9 per 5 mmHg higher mMAP 24 , p = 0.01), with a stepwise increase in hospital mortality at lower mMAP 24. Patients with mMAP 24 < 65 mmHg were at higher risk of hospital mortality (57% vs. 28%, adjusted OR 2.0, 95% CI 1.4-3.0, p < 0.001); no differences were observed between patients with mMAP 24 65-74 vs. ≥ 75 mmHg (p > 0.1). Conclusion: In patients with CS, we observed an inverse relationship between mMAP 24 and hospital mortality. The poor outcomes in patients with mMAP 24 < 65 mmHg provide indirect evidence supporting a MAP goal of 65 mmHg for patients with CS.

show abstract

Incidence and outcomes of acute kidney injury stratified by cardiogenic shock severity

Padkins

Breen

Diepen

et al. 2021

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Background Acute kidney injury (AKI) is common among patients with cardiogenic shock (CS) and it is independently associated with mortality. We sought to assess the prevalence, severity, and prognosis of AKI as a function of cardiogenic shock severity in unselected Cardiac Intensive Care Unit (CICU) patients. Methods We retrospectively reviewed admissions to the Mayo Clinic between 2007 to 2015 and stratified patients by the AKI stage (based on modified Kidney Disease: Improving Global Outcomes criteria) and Society for cardiovascular angiography and interventions (SCAI) shock stage. The association with in‐hospital mortality was analyzed using multivariable logistic regression. Results We included 9,311 unique patients with a mean age of 67 years and 37% females. SCAI shock stages A, B, C, D, and E were present in 47%, 30%, 15%, 7%, and 1% of patients. The incidence of AKI of any severity was 39% in the CICU and 51% during the hospitalization. Hospital mortality occurred in 8% of all patients, and the risk increased as a function of the rising AKI and SCAI shock stage. Worsening AKI stage was associated with increased adjusted hospital mortality (adjusted OR per AKI stage 1.22, 95% CI 1.10–1.36, p < .001). Higher AKI stages were associated with increased adjusted hospital mortality in SCAI stage A/B (p < .001), but not in SCAI stage C, D, or E (all p > .05). Conclusions Higher AKI stages were independently associated with mortality in CICU patients after accounting for shock severity and may add incremental prognostic utility in patients with lower SCAI stages.

show abstract

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Cited by 23 publications

References 29 publications

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

Association between mean arterial pressure during the first 24 hours and hospital mortality in patients with cardiogenic shock

Incidence and outcomes of acute kidney injury stratified by cardiogenic shock severity

Contact Info

Product

Resources

About