Predicting survival in patients with acute decompensated heart failure complicated by cardiogenic shock

Abstract

Background Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS. Methods and results Using logistic regression, univariable testing was performed to identify the variables potentially associated with 28-day mortality. We propose a new logistic model (ALC-Shock score) based on three easy parameters (age, serum creatinine and serum lactate at the ICU admission) as a powerful predictor of survival or successful bridge to heart replacement therapy at 28-day follow-up in this specific population. A multivariable analysis (logistic model) was performed to evaluate the association between selected variables and outcome (overall death at 28-day follow up). The score was then validated in a different cohort of 93 ADHF-CS patients and compared to a previous developed score (the Cardshock score). Overall, 28-day mortality was 34%. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73–0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55–0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66. Conclusions A simple score including age, lactates and creatinine on admission could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification.

A Survival Prediction for Acute Heart Failure Patients via Web-Based Dynamic Nomogram with Internal Validation: A Prospective Cohort Study

“…Reviewing the previous prognostic AHF models, study showed model based on three easy parameters (age, serum creatinine and lactate) was associated with regarding 28-day mortality in the acute decompensated HF complicated by cardiogenic shock. 61 Another study enrolled 1033 AHF patients in emergency setting exhibited elevated troponin and renal function were significant predictors of adverse events. 62 In addition, results via the AHEAD scoring system (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) also could be factor in assessing prognosis.…”

Construction of a web‐based dynamic nomogram for predicting the prognosis in acute heart failure

“…To date, there is a relative lack of consensus on which factors are key for the determination of patients with AHF. Some studies reported that demographic information (age), clinical manifestations (NYHA functional class, SBP, DBP, and MAP), pre‐existing conditions (diabetes mellitus and AF), medications (vasopressors), laboratory tests (NT‐proBNP, haemoglobin, sodium, albumin, creatinine, blood urea nitrogen, and eGFR), and 12‐lead resting ECG (RBBB) were significantly associated with OS 8,9,37–40 . However, in the other studies, there was no apparent association of demographic information (age), clinical manifestations (SBP and DBP), pre‐existing conditions (AF), medications, and laboratory tests (NT‐proBNP, haemoglobin, sodium, and creatinine) with long‐term survival 41–43 .…”

Efficacy of Shock Team Implementation for Cardiogenic Shock: A Systematic Review

“…Lastly, it is worth noting that the current body of evidence concerning the impact of CS teams on outcomes specifically related to Acute Decompensated Heart Failure with Cardiogenic Shock (ADHF-CS) patients is notably limited. Recent research has highlighted a rising prevalence of ADHF-CS when compared to cases of AMI-CS 46 . Consequently, further research in this realm is imperative to enhance our understanding of the distinct implications and benefits of CS teams for ADHF-CS patients.…”