Résumé
Cardiogenic shock (CS) remains a severe but poorly understood pathology. Many predictive death scores have been previously described but have focused in ischemic CS and took into account data related to the management of these patients. So, there is an urgent need for simple and objective criteria to assess the short-term CS mortality regardless of the initial etiology. Methods FRENSHOCK registry (NCT02703038) was a large prospective multicenter registry of CS patients admitted in intensive cardiac and general critical care units between April and October 2016 in France. Patients were included if they met the following three criteria:.
–low cardiac output defined by SBP<90mmHg and/or the need of amines, or a CI<2.2L/min/m2 (TTE or Swan-Ganz);
–elevation of left and/or right heart pressures defined by clinic/radiology/biology/echocardiography/Swan-Ganz;
–clinical and/or biological signs of hypoperfusion.
We studied factors related to 30d mortality using Kaplan–Meier analyses and Cox proportional hazards modeling.
772 patients were included (male 72%, age median 66y). Non-ischemic CS were predominant (64%) although type 1 infarction was infrequent (17%). Mortality at 30–days was 26%. Non-survivors were older, had more previous renal failure, marbles, and atrial fibrillation at admission. They had lower SBP and DBP. Diagnostic tests revealed higher arterial lactate–CRP–natriuretic peptids–kaliemia; and lower pH - prothrombin time–haemoglobin–eGFR but also LVEF. Multivariate analysis retained age, low systolic blood pressure, high arterial lactate, low eGFR, low LVEF as significant predictors of 30–days mortality. Ischemic etiology or type 1 infarction were not predictive.
Five simple, practical and easy to find signs were found significant predictors of short-term mortality and could be useful in providing a more accurate and stratified definition of CS's patients in order to tailor additional therapies.