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Clinical Characteristics and Predictors of In-Hospital Mortality in Patients With Cardiogenic Shock

Authors
 Jeong Hoon Yang  ;  Ki Hong Choi  ;  Young-Guk Ko  ;  Chul-Min Ahn  ;  Cheol Woong Yu  ;  Woo Jung Chun  ;  Woo Jin Jang  ;  Hyun-Joong Kim  ;  Bum Sung Kim  ;  Jang-Whan Bae  ;  Sang Yeub Lee  ;  Sung Uk Kwon  ;  Hyun-Jong Lee  ;  Wang Soo Lee  ;  Jin-Ok Jeong  ;  Sang-Don Park  ;  Seong-Hoon Lim  ;  Sungsoo Cho  ;  Taek Kyu Park  ;  Joo Myung Lee  ;  Young Bin Song  ;  Joo-Yong Hahn  ;  Seung-Hyuk Choi  ;  Hyeon-Cheol Gwon 
Citation
 CIRCULATION-HEART FAILURE, Vol.14(6) : e008141, 2021-06 
Journal Title
CIRCULATION-HEART FAILURE
ISSN
 1941-3289 
Issue Date
2021-06
MeSH
Adult ; Aged ; Aged, 80 and over ; Extracorporeal Membrane Oxygenation / adverse effects ; Heart Failure / complications ; Heart Failure / mortality* ; Heart-Assist Devices / adverse effects ; Hospital Mortality* ; Humans ; Male ; Middle Aged ; Myocardial Infarction / mortality* ; Registries ; Shock, Cardiogenic / diagnosis ; Shock, Cardiogenic / mortality* ; Shock, Cardiogenic / therapy ; Time Factors
Keywords
cardiogenic shock ; dopamine ; mortality ; norepinephrine
Abstract
Background: In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean patients with CS.

Methods: The RESCUE study (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With CS) is a multicenter, retrospective, and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality.

Results: In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and nonischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intraaortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multivariable analysis, age ≥70years (odds ratio [OR], 2.73 [95% CI, 1.89-3.94], P<0.001), body mass index <25 kg/m2 (OR, 1.52 [95% CI, 1.08-2.16], P=0.017), cardiac arrest at presentation (OR, 2.16 [95% CI, 1.44-3.23], P<0.001), vasoactive-inotrope score >80 (OR, 3.55 [95% CI, 2.54-4.95], P<0.001), requiring continuous renal replacement therapy (OR, 4.14 [95% CI, 2.88-5.95], P<0.001), mechanical ventilator (OR, 3.17 [95% CI, 2.16-4.63], P<0.001), intraaortic balloon pump (OR, 1.55 [95% CI, 1.07-2.24], P=0.020), and extracorporeal membrane oxygenator (OR, 1.85 [95% CI, 1.25-2.76], P=0.002) were independent predictors for in-hospital mortality.

Conclusions: The in-hospital mortality of patients with CS remains high despite the high utilization of mechanical circulatory support. Age, low body mass index, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure requiring various support devices were poor prognostic factors for in-hospital mortality. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.
Full Text
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.120.008141
DOI
10.1161/CIRCHEARTFAILURE.120.008141
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Ahn, Chul Min(안철민)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190436
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