Warren Alex, McCall Philip, Proudfoot Alastair, Gillon Stuart, Abu-Arafeh Ahmad, McKnight Angus John, Mudie Rosemary, Armstrong David, Tzolos Evangelos, Livesey John Andrew, Sinclair Andrew, Baston Veronica, Dalzell Jonathan, Owen Deborah, Fleming Lucy, Scott Ian, Puxty Alex, Lee Matthew My, Walker Fiona, Hobson Simon, Campbell Euan, Kinsella Michael, McGinnigle Eilidh, Docking Robert, Price Grant, Ramsay Alex, Bauld Richard, Herron Suzanne, Lone Nazir I, Mills Nicholas L, Hartley Louise
Royal Infirmary of Edinburgh, Edinburgh, UK.
Anaesthesia, Critical Care & Pain, University of Edinburgh, Edinburgh, UK.
J Intensive Care Soc. 2023 Dec 28;25(2):147-155. doi: 10.1177/17511437231217877. eCollection 2024 May.
Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown.
We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality.
In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%-3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02-1.06), admission lactate (OR 1.10, 95% CI 1.05-1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10-4.29) and use of adrenaline (OR 2.73, 95% CI 1.40-5.40) were associated with mortality.
In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.
尽管苏格兰心血管疾病发病率很高，但心源性休克患者的患病率和治疗结果尚不清楚。
我们对苏格兰13家医院重症监护病房（ICU）或冠心病监护病房连续收治的心源性休克患者进行了为期6个月的前瞻性观察队列研究。利用苏格兰重症监护学会审计组的分母数据来估计ICU患病率；冠心病监护病房的数据不可用。我们进行了多变量逻辑回归分析，以确定与院内死亡率相关的因素。
总共纳入了247例心源性休克患者。排除冠心病监护病房收治的患者后，这占研究期间所有ICU收治患者的3.0%（95%置信区间[CI]2.6%-3.5%）。病因是急性心肌梗死（AMI）的占48%。最常用的血管活性药物是去甲肾上腺素（56%），其次是肾上腺素（46%）和多巴酚丁胺（40%）。30%的患者使用了机械循环支持。总体院内死亡率为55%。多变量逻辑回归分析后，年龄（比值比[OR]1.04，95%CI 1.02-1.06）、入院时乳酸水平（OR 1.10，95%CI 1.05-1.19）、就诊时心血管造影介入学会D或E期（OR 2.16，95%CI 1.10-4.29）以及使用肾上腺素（OR 2.73，95%CI 1.40-5.40）与死亡率相关。
在苏格兰，心源性休克的患病率占所有ICU收治患者的3%；超过一半的患者在出院前死亡。治疗方法存在显著差异，尤其是在血管活性支持策略方面。
