Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University.
European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim.
Coron Artery Dis. 2023 Sep 1;34(6):395-403. doi: 10.1097/MCA.0000000000001241. Epub 2023 May 1.
The study investigates the prognostic impact of the prothrombin time/international normalized ratio (PT/INR) in patients with cardiogenic shock.
Despite ongoing improvements regarding the treatment of cardiogenic shock patients, intensive care unit (ICU)-related mortality in cardiogenic shock patients remains unacceptably high. Limited data regarding the prognostic value of the PT/INR during the course of cardiogenic shock treatment is available.
All consecutive patients with cardiogenic shock from 2019 to 2021 were included at one institution. Laboratory values were collected from the day of disease onset (day 1) and days 2, 3, 4 and 8. The prognostic impact of the PT/INR was tested for 30-day all-cause mortality, as well as the prognostic role of PT/INR changes during course of ICU hospitalization. Statistical analyses included univariable t -test, Spearman's correlation, Kaplan-Meier analyses, C-Statistics and Cox proportional regression analyses.
Two hundred twenty-four cardiogenic shock patients were included with a rate of all-cause mortality at 30 days of 52%. The median PT/INR on day 1 was 1.17. The PT/INR on day 1 was able to discriminate 30-day all-cause mortality in cardiogenic shock patients [area under the curve 0.618; 95% confidence interval (CI), 0.544-0.692; P = 0.002). Patients with PT/INR > 1.17 were associated with an increased risk of 30-day mortality [62% vs. 44%; hazard ratio (HR) = 1.692; 95% CI, 1.174-2.438; P = 0.005], which was still evident after multivariable adjustment (HR = 1.551; 95% CI, 1.043-2.305; P = 0.030). Furthermore, especially patients with an increment of the PT/INR by ≥10% from day 1 to day 2 were associated with an increased risk of 30-day all-cause mortality (64% vs. 42%; log-rank P = 0.014; HR = 1.833; 95% CI, 1.106-3.038; P = 0.019).
Baseline PT/INR and an increase of the PT/INR during the course of ICU treatment were associated with the risk of 30-day all-cause mortality in cardiogenic shock patients.
本研究旨在探讨凝血酶原时间/国际标准化比值（PT/INR）对心源性休克患者预后的影响。
尽管心源性休克患者的治疗不断取得进展，但重症监护病房（ICU）相关死亡率仍然高得令人无法接受。目前关于心源性休克治疗过程中 PT/INR 的预后价值的数据有限。
在一家机构纳入了 2019 年至 2021 年期间所有连续发生心源性休克的患者。从发病当天（第 1 天）以及第 2、3、4 和 8 天采集实验室值。测试了 PT/INR 在 30 天全因死亡率方面的预后价值，以及 ICU 住院期间 PT/INR 变化的预后作用。统计分析包括单变量 t 检验、Spearman 相关性、Kaplan-Meier 分析、C 统计量和 Cox 比例风险回归分析。
共纳入 224 例心源性休克患者，30 天全因死亡率为 52%。第 1 天的 PT/INR 中位数为 1.17。第 1 天的 PT/INR 能够区分心源性休克患者的 30 天全因死亡率[曲线下面积 0.618；95%置信区间（CI），0.544-0.692；P=0.002]。PT/INR＞1.17 的患者 30 天死亡率增加的风险增加[62%比 44%；风险比（HR）=1.692；95%CI，1.174-2.438；P=0.005]，这在多变量调整后仍然明显（HR=1.551；95%CI，1.043-2.305；P=0.030）。此外，尤其是从第 1 天到第 2 天 PT/INR 增加≥10%的患者，30 天全因死亡率增加的风险增加（64%比 42%；对数秩 P=0.014；HR=1.833；95%CI，1.106-3.038；P=0.019）。
心源性休克患者的基线 PT/INR 和 ICU 治疗过程中 PT/INR 的升高与 30 天全因死亡率的风险相关。
