Cardiogenic shock in intensive care units: evolution of prevalence, patient profile, management and outcomes, 1997-2012

Abstract

Aim: To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years.

Methods and results: From the 1997-2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes [Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality] and predictors of in-ICU mortality. Of the 316 905 ICU admissions, 19 416 (6.1%) exhibited CS, with incidence increasing from 4.1% to 7.7% (P < 0.001). Over time, the age of admitted patients decreased by 2.7 years [95% confidence interval (CI), -2.0 to -3.4] and SAPS-II increased by 5.8% (95% CI 4.8-6.8) from 58.7 ± 25.3 to 64.5 ± 23.3 (P < 0.001). Crude in-ICU mortality declined from 50% to 45% (-5.6%; 95% CI -7.7 to -3.5) as SAPS-II Standardized ICU mortality rates decreased from 56.5% to 44.2% (P < 0.001). A more recent time-period was an independent correlate of decreased mortality in multivariate analyses. The decrease in mortality rate was more marked in patients with decompensated heart failure, cardiac arrest, or acute myocardial infarction.

Conclusions: Patients with CS represent a greater proportion of patients admitted to ICUs over the past 15 years, having become younger but more critically ill. Although their mortality has decreased, suggesting improved overall patient management, it remains particularly high, warranting further research specifically focused on this population.

Keywords: Cardiogenic shock; Epidemiology; Intensive care unit; Mortality; Simplified Acute Physiology Score.