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

International Journal of Cardiology: Heart & Vasculature

Laura Antolini¹  Giovanna Viola²  Luca Villanova³  Alice Sacco⁴  Fabrizio Oliva⁴  Maurizio Bottiroli⁴  Laura De Ponti⁵  Arthur Reshad Garan⁶  Justin Fried⁷  Michela Dal Martello⁸  Maria Frigerio⁹  Paolo Colombo⁹  Carlo La Vecchia⁹  Gianfranco Alicandro⁹  Nuccia Morici⁹  Federico Pappalardo⁹ 

[1] Corresponding author.;Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy;Cardio-thoracic Intensive Care Unit and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy;Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy;Dept. Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Palermo;Division of Cardiology, Department of Medicine, Columbia University Medical Center–New York Presbyterian, NewYork, NewYork, USA;Heart Failure and Cardiac Transplant Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy;School of Medicine, Center of Bioststistics for Clinical Epidemiology, Univ. Milano Bicocca, Monza, Italy;Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy;

关键词: Cardiogenic shock;    Prognostication;    Net benefit;    Acute decompensated heart failure;    Heart replacement therapy;    Heart failure;   

DOI  :  

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown