Yu Yue, Rao Jin, Xu Qiumeng, Xiao Jian, Cheng Pengchao, Wang Junnan, Xi Wang, Wang Pei, Zhang Yufeng, Wang Zhinong
Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
Department of Orthopaedics, Changzheng Hospital, Naval Medical University, Shanghai, China.
Front Med (Lausanne). 2023 Jun 22;10:1186119. doi: 10.3389/fmed.2023.1186119. eCollection 2023.
Cardiogenic shock (CS) is increasingly recognized as heterogeneous in its severity and response to therapies. This study aimed to identify CS phenotypes and their responses to the use of vasopressors.
The current study included patients with CS complicating acute myocardial infarction (AMI) at the time of admission from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Laboratory and clinical variables were collected and used to conduct latent profile (LPA) analysis. Furthermore, we used a multivariable logistic regression (LR) model to explore the independent association between the use of vasopressors and endpoints.
A total of 630 eligible patients with CS after AMI were enrolled in the study. The LPA identified three profiles of CS: profile 1 ( = 259, 37.5%) was considered as the baseline group; profile 2 ( = 261, 37.8%) was characterized by advanced age, more comorbidities, and worse renal function; and profile 3 ( = 170, 24.6%) was characterized by systemic inflammatory response syndrome (SIRS)-related indexes and acid-base balance disturbance. Profile 3 showed the highest all-cause in-hospital mortality rate (45.9%), followed by profile 2 (43.3%), and profile 1 (16.6%). The LR analyses showed that the phenotype of CS was an independent prognostic factor for outcomes, and profiles 2 and 3 were significantly associated with a higher risk of in-hospital mortality (profile 2: odds ratio [OR] 3.95, 95% confidence interval [CI] 2.61-5.97, < 0.001; profile 3: OR 3.90, 95%CI 2.48-6.13, < 0.001) compared with profile 1. Vasopressor use was associated with an improved risk of in-hospital mortality for profile 2 (OR: 2.03, 95% CI: 1.15-3.60, = 0.015) and profile 3 (OR: 2.91, 95% CI: 1.02-8.32, = 0.047), respectively. The results of vasopressor use showed no significance for profile 1.
Three phenotypes of CS were identified, which showed different outcomes and responses to vasopressor use.
心源性休克（CS）在严重程度和对治疗的反应方面越来越被认为具有异质性。本研究旨在识别CS的表型及其对血管升压药使用的反应。
本研究纳入了医学重症监护信息数据库IV（MIMIC-IV）中入院时并发急性心肌梗死（AMI）的CS患者。收集实验室和临床变量并用于进行潜在类别分析（LPA）。此外，我们使用多变量逻辑回归（LR）模型来探讨血管升压药的使用与终点之间的独立关联。
本研究共纳入630例符合条件的AMI后CS患者。LPA识别出CS的三种类型：类型1（n = 259，37.5%）被视为基线组；类型2（n = 261，37.8%）的特征是年龄较大、合并症较多且肾功能较差；类型3（n = 170，24.6%）的特征是与全身炎症反应综合征（SIRS）相关的指标和酸碱平衡紊乱。类型3的全因院内死亡率最高（45.9%），其次是类型2（43.3%）和类型1（16.6%）。LR分析表明，CS的表型是结局的独立预后因素，与类型1相比，类型2和类型3与更高的院内死亡风险显著相关（类型2：比值比[OR] 3.95，95%置信区间[CI] 2.61 - 5.97，P < 0.001；类型3：OR 3.90，95%CI 2.48 - 6.13，P < 0.001）。血管升压药的使用分别与类型2（OR：2.03，95% CI：1.15 - 3.60，P = 0.015）和类型3（OR：2.91，95% CI：1.02 - 8.32，P = 0.047）的院内死亡风险改善相关。血管升压药使用的结果对类型1无显著意义。
识别出CS的三种表型，它们对血管升压药的使用表现出不同的结局和反应。
