Shock in the cardiac intensive care unit: Changes in epidemiology and prognosis over time

Jentzer, Jacob C.; Ahmed, Abdelrahman; Vallabhajosyula, Saraschandra; Burstein, Barry; Tabi, Meir; Barsness, Gregory W.; Murphy, Joseph G.; Best, Patricia J.M.; Bell, Malcolm R.

doi:10.1016/j.ahj.2020.10.054

Cited by 78 publications

(98 citation statements)

References 30 publications

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“…Shock is increasingly prevalent in the cardiac intensive care unit (CICU) and remains associated with substantial mortality. 1 , 2 , 3 Although cardiogenic shock (CS) predominates in the CICU, patients with concomitant sepsis or mixed cardiogenic-vasodilatory shock account for 15% to 20% of CICU patients with shock and have worse outcomes. 1 , 2 , 4 The severity of shock is an important predictor of mortality in CICU patients and in patients with sepsis, providing incremental risk stratification on top of standard severity of illness risk scores.…”

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confidence: 99%

“… 1 , 2 , 3 Although cardiogenic shock (CS) predominates in the CICU, patients with concomitant sepsis or mixed cardiogenic-vasodilatory shock account for 15% to 20% of CICU patients with shock and have worse outcomes. 1 , 2 , 4 The severity of shock is an important predictor of mortality in CICU patients and in patients with sepsis, providing incremental risk stratification on top of standard severity of illness risk scores. 5 , 6 Shock severity can be quantified using the Sequential Organ Failure Assessment (SOFA) cardiovascular subscore 5 , 7 , 8 or the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification.…”

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Shock Severity Assessment in Cardiac Intensive Care Unit Patients With Sepsis and Mixed Septic-Cardiogenic Shock

Jentzer

Diepen

Hollenberg

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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We sought to validate the Society for Cardiovascular Angiography and Interventions (SCAI) cardiogenic shock classification for mortality risk stratification in patients with sepsis and concomitant cardiovascular disease or mixed septic-cardiogenic shock. We conducted a single-center retropective cohort study of cardiac intensive care unit patients with an admission diagnosis of sepsis. We used clinical, vital sign, and laboratory data during the first 24 hours after admission to assign SCAI shock stage. We included 605 patients with a median age of 69.4 years (interquartile range, 57.9 to 79.8 years), 222 of whom (36.7%) were female. Acute coronary syndrome or heart failure was present in 480 patients (79.3%), and cardiogenic shock or cardiac arrest was present in 271 patients (44.8%). The median day 1 Sequential Organ Failure Assessment (SOFA) cardiovascular subscore was 1.5 (interquartile range, 1 to 4), and the admission SCAI shock stage distribution was stage B, 40.7% (246); stage C, 19.3% (117); stage D, 32.9% (199); and stage E, 7.1% (43). In-hospital mortality occurred in 177 of the 605 patients (29.3%) and increased incrementally with higher SCAI shock stage. After multivariable adjustment, admission SCAI shock stage was associated with in-hospital mortality (adjusted odds ratio per stage, 1.46; 95% CI, 1.14 to 1.88; P =.003). Admission SCAI shock stage had higher discrimination for in-hospital mortality than the day 1 SOFA cardiovascular subscore (area under the receiver operating characteristic curve, 0.68 vs 0.64; P =.04 by the DeLong test). Admission SCAI shock stage was associated with 1-year mortality (adjusted hazard ratio per stage, 1.19; 95% CI, 1.03 to 1.37; P =.02). The SCAI shock classification provides improved mortality risk stratification over the day 1 SOFA cardiovascular subscore in cardiac intensive care unit patients with sepsis and concomitant cardiovascular disease or mixed septic-cardiogenic shock.

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Shock Severity Assessment in Cardiac Intensive Care Unit Patients With Sepsis and Mixed Septic-Cardiogenic Shock

Jentzer

Diepen

Hollenberg

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…SIRS results in a vasodilatory state (including arteries and veins) and can worsen cardiac function that further complicate management and has a negative impact on prognosis. In addition, over time with persistent neurohormonal activation, inflammation and hemodynamic forces, ventricular remodeling ensues (6), which underlies the development and progression of heart failure.…”

Section: Initial Evaluation Of Cardiogenic Shockmentioning

confidence: 99%

Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

Abraham

Blumer

Burkhoff

et al. 2021

Journal of Cardiac Failure

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“…Demographics, vital signs, laboratory results, diagnoses, procedures, therapies and length of stay (LOS) were extracted from the electronic medical record (EMR) through the Multidisciplinary Epidemiology and Translational Research in Intensive Care Data Mart [18,19]. Admission diagnoses were defined as all International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes recorded within one day before or after CICU admission [20,21]. EMR data during the first 24 hours of CICU admission were used to automatically calculate the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE)-III scores and APACHE-IV predicted mortality via imputation of missing variables as normal [15][16][17][22][23][24].…”

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Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients

et al. 2021

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Purpose We sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients. Materials and methods We retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis. Results 9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5–3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6–2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6–2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1–1.6; p<0.001). Conclusion Abnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.

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Shock in the cardiac intensive care unit: Changes in epidemiology and prognosis over time

Cited by 78 publications

References 30 publications

Shock Severity Assessment in Cardiac Intensive Care Unit Patients With Sepsis and Mixed Septic-Cardiogenic Shock

Shock Severity Assessment in Cardiac Intensive Care Unit Patients With Sepsis and Mixed Septic-Cardiogenic Shock

Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

Abnormal serum chloride is associated with increased mortality among unselected cardiac intensive care unit patients

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