1 Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland.
2 Cardiology, University of Helsinki, Heart and Lung Centre, Helsinki University Hospital, Finland.
Eur Heart J Acute Cardiovasc Care. 2018 Feb;7(1):38-44. doi: 10.1177/2048872617702505. Epub 2017 Apr 13.
Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock.
Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status.
Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1-2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status.
Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.
意识状态改变是心源性休克（急性心力衰竭最严重的形式）低灌注的征象之一。本研究旨在调查意识状态改变的发生率，确定与之相关的因素，并评估心源性休克患者意识状态改变的预后意义。
在一项多中心、前瞻性、观察性研究中，对 215 例成年心源性休克患者休克发作时的意识状态进行评估。比较了意识状态改变和正常的患者的临床表现、生化指标和短期死亡率。
意识状态改变在 147 例（68%）患者中被发现，而 68 例（32%）患者的意识状态正常。与意识状态正常的患者相比，意识状态改变的患者年龄更大（68 岁 vs. 64 岁，p=0.04），更有可能患有急性冠状动脉综合征（85% vs. 74%，p=0.04）。意识状态改变与较低的收缩压（76 毫米汞柱 vs. 80 毫米汞柱，p=0.03）和较低的动脉 pH（7.27 vs. 7.35，p<0.001）以及更高的血乳酸水平（3.4 毫摩尔/升 vs. 2.3 毫摩尔/升，p<0.001）和血糖水平（11.4 毫摩尔/升 vs. 9.0 毫摩尔/升，p=0.01）相关。低动脉 pH（调整后的优势比 1.6（1.1-2.2），p=0.02）是唯一与意识状态改变相关的独立因素。意识状态改变的患者 90 天死亡率明显更高（51% vs. 22%，p<0.001）。
意识状态改变是心源性休克全身低灌注的常见临床征象，与不良预后相关。它还与一些反映组织灌注不足的生化发现有关，其中动脉 pH 值低与意识状态改变独立相关。
