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Multicenter Study
. 2021 Apr;8(2):1398-1407.
doi: 10.1002/ehf2.13224. Epub 2021 Jan 31.

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

Mari Hongisto  1 , Johan Lassus  2 , Tuukka Tarvasmäki  2 , Alessandro Sionis  3 , Jordi Sans-Rosello  3 , Heli Tolppanen  2 , Anu Kataja  1 , Toni Jäntti  2 , Tuija Sabell  2 , Matias Greve Lindholm  4 , Marek Banaszewski  5 , Jose Silva Cardoso  6 , John Parissis  7 , Salvatore Di Somma  8 , Valentina Carubelli  9 , Raija Jurkko  2 , Josep Masip  10 , Veli-Pekka Harjola  1 ; CardShock Study Investigators and the GREAT Network
Affiliations
Multicenter Study

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

Mari Hongisto et al. ESC Heart Fail. 2021 Apr.

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.

Keywords: Biomarker; Cardiogenic shock; Elderly; GDF-15; Risk prediction; sST2.

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Conflict of interest statement

J.L. has received fees for lectures and advisory board meetings from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, Roche Diagnostics, and Vifor Pharma. J.P. received honoraria for advisory meetings and lectures from Orion Pharma and Roche Diagnostics. V.C. received consulting honoraria from CVie Therapeutics Limited, Servier, and Windtree Therapeutics. All other authors have no conflicts to declare.

Figures

Figure 1
Figure 1
Survival in patients with cardiogenic shock by the age group. Kaplan–Meier survival curves for all‐cause mortality in the elderly (≥75 years old) (dashed line) and the younger (<75 years old) (solid line) patients with cardiogenic shock. (A) In‐hospital mortality (46% in the elderly and 33% in the younger) for all patients. (B) One year mortality (10% in the elderly and 12% in the younger) for those surviving hospitalization.
Figure 2
Figure 2
In‐hospital mortality by the risk categories in the elderly and the younger with cardiogenic shock. Distribution of the patients (%; bars) and in‐hospital mortality (%, dashed lines) according to the risk category (low, intermediate, and high) in the elderly (≥75 years) and in the younger (<75 years) patients with cardiogenic shock in (A) CardShock risk score and (B) IABP‐SHOCK II score.
Figure 3
Figure 3
Elderly survivors and non‐survivors and the risk model categories. Distribution (%) of the elderly (≥75 years) in‐hospital survivors and non‐survivors in different risk categories in (A) CardShock risk score (n = 53) and (B) IABP‐SHOCK II score (n = 33). Numbers above the bars indicate the number of the patients in each category.
See this image and copyright information in PMC

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