engleski

A simplified risk score inspired by cardshock score to predict short-term mortality in patients with cardiogenic shock

Background: Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion characterized by high early mortality. In 2015, the CardShock score was developed as a risk prediction tool for mortality in patients with cardiogenic shock. Purpose: 1) To validate the CardShock score for risk stratification in our population ; 2) To assess whether a parsimonious model may perform equally well for prediction of short-term mortality in patients (pt) with CS. Methods: Clinical and laboratory data of 165 patients admitted for CS to two Italian ICCU during 4 years (2013–2016) were retrospectively examined. CardShock additive score was calculated for each pt. Variables significantly associated with in-hospital mortality by univariable logistic regression were entered in a multivariable model. C- statistic and Hosmer- Lemeshow test were used to assess the model predictive accuracy and goodness of fit. Results: A studied population (69±12.7 years, 69% men) had a mean MAP (mean arterial pressure) of 60±16 mmHg, severe LV dysfunction (left ventricular ejection fraction – LVEF: 28±11%), and moderate renal failure (eGFR (CKD- EPI): 51.1±27.2 mL/min/1.73m2). Serum lactates averaged 6.6±5.3 mmol/L. The chief admission diagnosis was acute coronary syndrome (64% STEMI and 11% NSTEMI). A 73%of pt received intra-aortic balloon pump (IABP). The in- hospital mortality was 47%. Per established CardShock variables, a multivariable analysis (Table 1) showed that patient' age, serum lactates and LVEF at admission had the highest statistical correlation with mortality outcomes in our sample. Therefore, a new risk score composed of these three variables that stratified the population in three mortality risk classes was created. Our results show that this risk score performed better in a prediction of in-hospital and 30-day mortality (AUC 0.82 95% CI 0.76–0.89 and AUC 0.79 95% CI 0.71–0.86, respectively) than the CardShock score (AUC 0.72 (95% CI 0.64–0.79), in our cardiogenic shock population (Figure 1). Conclusions: The use of a simplified score is equally or even more reliable than CardShock risk score for the prediction of in-hospital mortality in pt with CS. This simplified score can be calculated in few minutes and is highly accurate, allowing to decide the best treatment options without further delay.

cardiogenic shock ; mortality ; risk stratification ;

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