Predicting outcomes in cardiogenic shock: are we at risk of having too many scores but too little information?

López-Sobrino, Teresa; Yusef, Hakeem; Gershlick, Tony

doi:10.1093/eurheartj/ehz488

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…In an attempt to predict outcomes and to identify high risk patients, risk scores including different clinical parameters were developed. However, the question “Are we at risk of having too many scores but too little information?”—posed by Dr. Teresa Lopez-Sobrino remains relevant [ 65 ]. Presented scoring systems have a number of limitations, some of the variables are to a certain extent subjective.…”

Section: Discussionmentioning

confidence: 99%

Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction

Muzafarova

Motovska

2022

Biomedicines

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Cardiogenic shock is a state of reduced cardiac output leading to hypotension, pulmonary congestion, and hypoperfusion of tissues and vital organs. Despite the advances in intensive care over the last years, the morbidity and mortality of patients remain high. The available studies of patients with cardiogenic shock suggest a connection between clinical variables, the level of biomarkers, the results of imaging investigations, strategies of management and the outcome of this group of patients. The management of patients with cardiogenic shock initially complicating acute myocardial infarction is challenging, and the number of studies in this area is growing fast. The purpose of this review is to summarize the currently available evidence on cardiogenic shock initially complicating acute myocardial infarction with particular attention to predictors of prognosis, focusing on laboratory variables (established and new), and to discuss the practical implementation. Currently available scoring systems developed during the past few decades predict the clinical outcome of this group of patients using some of the established biomarkers among other variables. With the new laboratory biomarkers that have shown their predictive value in cardiogenic shock outcomes, a new design of scoring systems would be of interest. Identifying high-risk patients offers the opportunity for early decision-making.

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Section: Discussionmentioning

confidence: 99%

Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction

Muzafarova

Motovska

2022

Biomedicines

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“…The risk factors included in these models were mostly from the medical history and biochemistry results at admission; (3)(4)(5) however, CS is a critical condition that is ever-evolving from preshock to refractory shock states. Thus factors during a patient's acute care management may also affect the prognosis (2,8). Besides, optimal management of CS requires timely interventions to prevent multiorgan system dysfunction (6).…”

Section: Introductionmentioning

confidence: 99%

The CSP (Cardiogenic Shock Prognosis) Score: A Tool for Risk Stratification of Cardiogenic Shock

Tien

Chen

Huang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCardiogenic shock (CS) is a critical condition and the leading cause of mortality after acute myocardial infarction (AMI). Scores that predict mortality have been established, but a patient's clinical course is often nonlinear. Thus, factors present during acute care management may be explored. This study intended to develop a risk-predictive model for patients with CS.MethodsIn this observational study, adult patients who received inotropic support at the Emergency Room (ER) from January 2017 to August 2020 and were admitted to the cardiac care unit (CCU) with a diagnosis of CS were enrolled in this study. Patients with out-of-hospital cardiac arrest, inotropic support for bradycardia, and survival <24 h after ER arrival were excluded. A total of 311 patients were enrolled and categorized into derivation (n = 243) and validation (n = 68) cohorts.ResultsA history of coronary artery disease, multiple inotrope use, ejection fraction <40%, lower hemoglobin concentration, longer cardiopulmonary resuscitation duration, albumin infusion, and renal replacement therapy were identified as independent prognostic factors for in-hospital mortality. The cardiogenic shock prognosis (CSP) score was established as a nomogram and three risk groups were identified: low-risk (score 115, 0% of mortality), medium-risk (score 116–209, 8.75% of mortality), and high-risk (score 210, 66.67% of mortality). The area-under-the-curve (AUC) of the CSP score was 0.941, and the discrimination value in the validation cohort was consistent (AUC = 0.813).ConclusionsThe CSP score represents a risk-predictive model for in-hospital mortality in patients with CS in acute care settings. Patients identified as the high-risk category may have a poor prognosis.

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“…Furthermore, a patient's clinical course is often nonlinear, and thus factors throughout their hospitalization should be explored. 11 Therefore, this study aimed to develop a risk-predictive model of inhospital mortality for patients with CS based on their medical history, examination results, and interventions throughout hospitalization to aid physicians in their clinical management and to improve patients' prognoses.…”

Section: Introductionmentioning

confidence: 99%

Predictive Nomogram of the in-Hospital Mortality of Patients with Cardiogenic Shock

Tien¹,

Chen²,

Huang³

et al. 2021

Preprint

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BackgroundDespite advances in treatment, the mortality rates of patients with cardiogenic shock (CS) remain high. The aim of this study was to develop a risk-predictive model for in-hospital mortality in patients admitted to the cardiac care unit (CCU) because of CS. Methods This retrospective study enrolled 509 adult patients who received inotropic support at the emergency room with subsequent admission to the CCU from January 2017 to December 2019. Patients with out-of-hospital cardiac arrest, inotrope use for conduction disorders, and non-CS were excluded. A total of 246 patients were analyzed using multiple logistic regression. ResultsA history of coronary artery disease (OR 3.44), multiple inotropic use (OR 17.70), ejection fraction less than 40% (OR 0.27), longer cardiopulmonary resuscitation (CPR) duration (OR 1.11), albumin infusion (OR 4.66), and renal replacement therapy (OR 3.08) were associated with higher in-hospital mortality. These factors were used to develop a risk-predictive nomogram. A receiver operating characteristic (ROC) curve was drawn using scores from 0 to 198.5 (area under the curve [AUC] = 0.92), and the cut-off score of 65 was identified. The model accurately predicted mortality (AUC = 0.81) in a validation set of 68 patients, with a sensitivity of 81% and a specificity of 74%. Conclusion Factors were used to develop a highly accurate risk-predictive nomogram for the in-hospital mortality of patients with CS, which may aid physicians in making prognoses.

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Predicting outcomes in cardiogenic shock: are we at risk of having too many scores but too little information?

Cited by 8 publications

References 24 publications

Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction

Laboratory Predictors of Prognosis in Cardiogenic Shock Complicating Acute Myocardial Infarction

The CSP (Cardiogenic Shock Prognosis) Score: A Tool for Risk Stratification of Cardiogenic Shock

Predictive Nomogram of the in-Hospital Mortality of Patients with Cardiogenic Shock

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