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. 2025 Feb 25:S1071-9164(25)00097-1.
doi: 10.1016/j.cardfail.2024.12.017. Online ahead of print.

Epidemiology and Prognostic Significance of Acute Noncardiac Organ Dysfunction Across Cardiogenic Shock Subtypes

Anubodh S Varshney  1 , Michael G Palazzolo  2 , Christopher F Barnett  3 , Erin A Bohula  2 , James A Burke  4 , Sunit-Preet Chaudhry  5 , Meshe D Chonde  6 , Shahab Ghafghazi  7 , Daniel A Gerber  1 , Benjamin Kenigsberg  8 , Michael C Kontos  9 , Younghoon Kwon  10 , Patrick R Lawler  11 , Daniel B Loriaux  12 , Venu Menon  13 , P Elliott Miller  14 , Connor G O'Brien  3 , Alexander I Papolos  8 , Siddharth M Patel  2 , Brian J Potter  15 , Rajnish Prasad  16 , Kevin S Shah  17 , Shashank S Sinha  18 , Michael A Solomon  19 , Andrea Thompson  20 , Jeffrey J Teuteberg  1 , Sean VAN Diepen  21 , David A Morrow  2 , David D Berg  22
Affiliations

Epidemiology and Prognostic Significance of Acute Noncardiac Organ Dysfunction Across Cardiogenic Shock Subtypes

Anubodh S Varshney et al. J Card Fail. .

Abstract

Background: The epidemiology and prognostic significance of acute noncardiac organ dysfunction across cardiogenic shock (CS) subtypes are not well-defined.

Methods: CS admissions from 2017 to 2022 in the Critical Care Cardiology Trials Network Registry were classified as acute myocardial infarction-related CS (AMI-CS), acute-on-chronic heart failure-related CS (AoC HF-CS), or de novo HF-CS, and categorized as having at least moderate respiratory, kidney, liver, and/or neurological dysfunction using established criteria. Burden of organ dysfunction was defined as no noncardiac organ dysfunction (NOD), single organ dysfunction, or multiorgan dysfunction (≥2) (MOD). Multivariable models were used to evaluate associations of burden and type of noncardiac organ dysfunction with in-hospital death.

Results: Among 3904 CS admissions, 29.4% had AMI-CS, 50.9% had AoC HF-CS, and 19.7% had de novo HF-CS. AMI-CS and de novo HF-CS had greater prevalence of MOD (35.0% and 33.9%, respectively) compared with AoC HF-CS (23.1%; P < .01). In-hospital mortality was higher with a greater burden of organ dysfunction in the overall CS cohort (single organ dysfunction vs NOD, adjusted odds ratio [aOR] for in-hospital death 2.5, 95% confidence interval [CI] 2.0-3.2; MOD vs NOD: aOR 6.5, 95% CI 5.1-8.2) and across each CS subtype. Kidney dysfunction was the most prognostically important form of organ dysfunction in the overall cohort (aOR 4.1, 95% CI 3.4-5.0) and for each CS subtype.

Conclusions: Admissions for AoC HF-CS had a lower burden of acute noncardiac organ dysfunction compared with admissions for de novo HF-CS and AMI-CS. However, acute noncardiac organ dysfunction burden was similarly adversely prognostic across all CS subtypes.

Keywords: Cardiogenic shock; heart failure; organ dysfunction; outcomes.

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Conflict of interest statement

Conflicts of Interest AV reports consulting fees from Broadview Ventures, Hippocratic AI, Baim Institute for Clinical Research, and ECHAS. DB has received honoraria from the Medical Education Speakers Network and USV Private Limited; consulting fees from AstraZeneca, MobilityBio, Pfizer, and Youngene Therapeutics; and serves on clinical endpoint committees for studies sponsored by Beckman Coulter, CeleCor, Kowa Pharmaceuticals, Novo Nordisk, and Tosoh Biosciences. JT reports relationships with Abbott (consulting), Abiomed (ad board), Broadview Ventures (consulting), CareDx (ad board, speaking), Cytokinetics (speaking), Medtronic (ad board, speaking, consulting), Paragonix (speaking), and Takeda (ad board). MK reports being a clinical trial end point adjudicator for Beckman Coulter. MS reports research support from the National Institutes of Health Clinical Center intramural research funds. EB, SP, DM, and DB are members of the TIMI Study Group, which has received institutional research grant support through Brigham and Women's Hospital from Abbott Laboratories, Abiomed, Amgen, Anthos Therapeutics, Arca Biopharma, AstraZeneca, Daiichi‐Sankyo, Intarcia, Janssen, Merck, Novartis, Pfizer, Poxel, Quark Pharmaceuticals, Regeneron, Roche, Siemens, and Zora Biosciences. DM has received consulting fees from Abbott Laboratories, Arca Biopharma, InCarda, Inflammatix, Merck, Novartis, Regeneron, and Roche Diagnostics. All other authors have no relevant disclosures.

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