Mortality risk prediction in elderly patients with cardiogenic shock: results from the CardShock study

ESC Heart Failure

for the CardShock Study Investigators and the GREAT Network¹  Jose Silva Cardoso²  Jordi Sans‐Rosello³  Alessandro Sionis³  Valentina Carubelli⁴  Toni Jäntti⁵  Tuukka Tarvasmäki⁵  Heli Tolppanen⁵  Johan Lassus⁵  Tuija Sabell⁵  Raija Jurkko⁵  Josep Masip⁶  Matias Greve Lindholm⁷  Salvatore Di Somma⁸  Mari Hongisto⁹  Anu Kataja⁹  Veli‐Pekka Harjola⁹  John Parissis^1,10  Marek Banaszewski^1,11 

[1] ;CINTESIS—Center for Health Technology and Services Research, Department of Cardiology, Faculty of Medicine University of Porto, São João University Medical Centre Porto Portugal;Cardiology Department Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute IIB‐Sant Pau, CIBER‐CV Barcelona Spain;Cardiology Division, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University and Civil Hospital of Brescia Brescia Italy;Cardiology, University of Helsinki and Heart and Lung Centre Helsinki University Hospital Helsinki Finland;Critical Care Department Hospital Sant Joan Despi Moisès Broggi, Consorci Sanitari Integral, University of Barcelona Barcelona Spain;Department of Cardiology Zealand University Hospital Roskilde Denmark;Department of Medical Surgery, Sciences and Translational Medicine Sapienza University of Rome Rome Italy;Division of Emergency Medicine, Department of Emergency Medicine and Services Helsinki University Hospital PO Box 900 Helsinki 00029 HUS Finland;ER and Heart Failure Unit Attikon University Hospital Athens Greece;Intensive Cardiac Therapy Clinic National Institute of Cardiology Warsaw Poland;

关键词: Cardiogenic shock;    Elderly;    Risk prediction;    Biomarker;    GDF‐15;    sST2;   

DOI  :  10.1002/ehf2.13224

来源: DOAJ

【 摘 要 】

Abstract Aims This study aimed to assess the utility of contemporary clinical risk scores and explore the ability of two biomarkers [growth differentiation factor‐15 (GDF‐15) and soluble ST2 (sST2)] to improve risk prediction in elderly patients with cardiogenic shock. Methods and results Patients (n = 219) from the multicentre CardShock study were grouped according to age (elderly ≥75 years and younger). Characteristics, management, and outcome between the groups were compared. The ability of the CardShock risk score and the IABP‐SHOCK II score to predict in‐hospital mortality and the additional value of GDF‐15 and sST2 to improve risk prediction in the elderly was evaluated. The elderly constituted 26% of the patients (n = 56), with a higher proportion of women (41% vs. 21%, P < 0.05) and more co‐morbidities compared with the younger. The primary aetiology of shock in the elderly was acute coronary syndrome (84%), with high rates of percutaneous coronary intervention (87%). Compared with the younger, the elderly had higher in‐hospital mortality (46% vs. 33%; P = 0.08), but 1 year post‐discharge survival was excellent in both age groups (90% in the elderly vs. 88% in the younger). In the elderly, the risk prediction models demonstrated an area under the curve of 0.75 for the CardShock risk score and 0.71 for the IABP‐SHOCK II score. Incorporating GDF‐15 and sST2 improved discrimination for both risk scores with areas under the curve ranging from 0.78 to 0.84. Conclusions Elderly patients with cardiogenic shock have higher in‐hospital mortality compared with the younger, but post‐discharge outcomes are similar. Contemporary risk scores proved useful for early mortality risk prediction also in the elderly, and risk stratification could be further improved with biomarkers such as GDF‐15 or sST2.

【 授权许可】

Unknown