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

Abstract

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.

Longitudinal study evaluating post-ICU syndrome differences between acute care surgery and trauma SICU survivors

“…A recent publication has demonstrated that shock severity at admission is a predictor of worse one-year mortality. 27 This observation appears consistent with Hawkins et al 28 who suggested that a genomic or cytokine storm at the time of initial illness is a factor in the development of chronic critical illness. Moreover, it was recognized that 15% of patients did not develop PICS.…”

“…Since we found that ACS patients had a higher occurrence of these conditions, it may warrant further examination of degree of inpatient illness. A recent publication has demonstrated that shock severity at admission is a predictor of worse one-year mortality 27 . This observation appears consistent with Hawkins et al 28 who suggested that a genomic or cytokine storm at the time of initial illness is a factor in the development of chronic critical illness.…”

Application of the SCAI classification to admission of patients with cardiogenic shock: Analysis of a tertiary care center in a middle-income country

“…Our results are consistent with data obtained in previous studies, indicating that mortality was substantially higher among patients with SCAI stages D and E (75.2% and 88.3%, respectively), who were identified as having advanced hemodynamic and metabolic shock states at admission (lactic acidosis, renal impairment, and liver injury). The application of the SCAI shock stage to our study population showed high discrimination for 30-day mortality, similar to that reported by Jentzer et al (AUC, 0.65 vs 0.68) [18]. Another important finding is the very high mortality (70%) in the first 72 hours after admission in patients with shock stages D and E.…”

Analysis of early risk factors for the lethal outcome of abdominal sepsis as indications for the start of invasive monitoring of central hemodynamics: a retrospective observational study

“…Более того, в настоящее время получены свидетельства связи компонентов этой шкалы с нарушениями при сепсисе внутриклеточных сигнальных пу тей, изменениями уровня матричной и митохондриальной РНК [24]. Указывают, что кардиальная подшкала SOFA в первые 24 ч нахождения в ОРИТ может стратифицировать риск летальности у больных с сепсисом и сопутствующими сердечно-сосудистыми заболеваниями, а также при сочетании септического и кардиогенного шока [25]. Установленные в настоя щей работе ППК и ПЗ оценки по SOFA, указывающие на высокий риск летального исхода, практически совпали с результатами наиболее современных исследований, посвященных предикторной способности этой шкалы [26].…”