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Observational Study
. 2024 Aug 1;84(2):210-219.
doi: 10.1097/FJC.0000000000001584.

Clinical Characteristics, Management, and Outcomes in Cardiogenic Shock: Insights From a High-Volume Italian Cardiac Intensive Care Unit

Marco Giuseppe Del Buono  1   2 , Giulia La Vecchia  1   2   3 , Alessia D'Aiello  1   2 , Daniela Pedicino  1   2 , Gaetano Pinnacchio  1   2 , Lorenzo Genuardi  2 , Rocco Antonio Montone  1   2 , Gianluigi Saponara  2 , Antonio Di Renzo  1   2 , Cristina Conte  1   2 , Francesco Cribari  1   2 , Francesco Moroni  4 , Simone Filomia  1   2 , Mattia Brecciaroli  1   2 , Cristina Aurigemma  1   2 , Giovanna Liuzzo  1   2 , Carlo Trani  1   2 , Francesco Burzotta  1   2 , Tommaso Sanna  1   2
Affiliations
Observational Study

Clinical Characteristics, Management, and Outcomes in Cardiogenic Shock: Insights From a High-Volume Italian Cardiac Intensive Care Unit

Marco Giuseppe Del Buono et al. J Cardiovasc Pharmacol. .

Abstract

Cardiogenic shock (CS) is a life-threatening condition. The aim of this study is to evaluate the clinical characteristics, management, and complication rate of patients with CS admitted to a high-volume hospital in Italy. We retrospectively reviewed the clinical, echocardiographic, and laboratory data, therapeutic management, and outcomes of patients with CS admitted to the Policlinico Gemelli (Rome) between January 1, 2020, and January 1, 2023. We included 96 patients [median age 71 years, interquartile range 60-79; 65 (68%) males], of whom 49 patients (51%) presented CS secondary to acute myocardial infarction and 60 (63%) with a de novo presentation of CS. Dobutamine was the most frequently used inotrope and noradrenaline the most frequently used vasopressor (adopted in 56% and 82% of cases, respectively). Forty-five (47%) patients died during the hospitalization. Nonsurvivors were older and had a higher inflammatory burden at admission, elevated lactate levels, a greater increase in lactate levels, higher left ventricular filling pressures, and worse right ventricular function. C-reactive protein levels [odds ratio (OR) 1.03, 95% confidence interval (CI) (1.00-1.04), P = 0.027], lactate levels at admission (OR 3.49, 95% CI, 1.59-7.63, P = 0.02), and increase in lactate levels (OR 2.8, 95% CI, 1.37-5.75, P = 0.005) were independent predictors of in-hospital all-cause death. Our data contribute to the assessment of the regional variations in the management and outcomes of patients with CS. We observed a high mortality and complication rate. Lactate acidosis and C-reactive protein measured at admission may help in identifying patients at higher risk of adverse in-hospital outcomes.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Clinical characteristics of the population cohort of patients with CS. This figure illustrates the demographic characteristics (age, sex, comorbidities), the clinical presentations on admission according to the SCAI shock stage, the etiology, and the treatments administrated in our cohort of patients with CS.
FIGURE 2.
FIGURE 2.
Prevalence of in-hospital complications among patients with CS. This figure illustrates the distribution of in-hospital complications among our population cohort of patients with CS and survivors versus nonsurvivors.
FIGURE 3.
FIGURE 3.
ROC curve analysis for CRP to predict in-hospital complications. ROC curve analysis showed an AUC for CRP levels to predict in-hospital mortality of 0.793 (P < 0.01).
FIGURE 4.
FIGURE 4.
Correlation between CRP at admission and delta interval changes in lactic acid levels. The scatterplot graph illustrates the correlation between delta interval changes in lactic acid levels and CRP at admission (R = +0.326, P = 0.01).
See this image and copyright information in PMC

References

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