Guido Tavazzi, Giovanni Tricella, Elena Garbero, Anna Zamperoni, Michele Zanetti, Stefano Finazzi
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Golgi 19, 27100 Pavia, Italy.
Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Viale Golgi 19, 27100 Pavia, Italy.
Eur Heart J Acute Cardiovasc Care. 2024 Dec 3;13(11):768-778. doi: 10.1093/ehjacc/zuae108.
Cardiogenic shock (CS) is a life-threatening disease burdened by a mortality up to 50%. The epidemiology has changed with non-ischaemic aetiologies being predominant, although data were mainly derived from patients admitted to dedicated acute cardiac care. We report the epidemiology and outcome of patients with CS admitted to general intensive care unit (ICU).
Prospective multicentric epidemiological study including 314 general ICU adhering to the GiViTI nationwide registry from 2011 to 2018, excluding cardiac arrest. The primary endpoint of the study was mortality. The association between clinical factors and mortality was evaluated using a logistic regression model. The odds ratios (ORs) of the covariates quantify their association with mortality during hospitalization. A total of 11 052 patients admitted to general ICU {incidence 2.17%; median age 72 [interquartile range (66-81)], 38.7% were women} with CS were included. Forty-seven per cent of patients had more than three organ insufficiency at the time of admission. The most common CS aetiologies were left heart failure (LHF, 5247-47.5%); acute myocardial infarction (3612-32.6%); right heart failure (RHF, 515-4.6%); and biventricular failure (532-4.8%). A total of 85.5% were mechanically ventilated during the ICU hospitalization. The overall ICU mortality was 44.8%, increasing to 53.4% during the hospitalization in the index hospital and to 54.3% at the latest hospital. Right heart failure-cardiogenic shock patients exhibited the highest mortality risk [OR: 1.19, 95% confidence interval (CI) (0.94-1.50); P < 0.001], followed by biventricular CS [OR 1.04, 95% CI (0.82-1.32)]. Respiratory failure [OR 1.13 (95% CI 1.08-1.19)], coagulation disorder [1.17 (95% CI 1.1-1.24)], renal dysfunction [OR 1.55 (95% CI 1.50-1.61)], and neurological alteration [OR 1.45 (95% CI 1.39-1.50)] were associated with worsen outcome along with severe hypotension [systolic blood pressure < 70 mmHg-OR 2.35, 95% CI (2.06-2.67)], increasing age [OR 2.21 95% CI (2.01-2.42)], and longer ICU stay prior to admission (two-fold increase for each 4.7 days).
In the general ICU, the aetiology of CS, excluding cardiac arrest, remains characterized mostly by LHF with RHF-CS burdened by higher mortality. Multiorgan failure at admission and longer hospital stay before ICU admission predispose to worsen outcome.
心源性休克（CS）是一种危及生命的疾病，死亡率高达50%。尽管数据主要来源于入住专门急性心脏护理病房的患者，但随着非缺血性病因占主导地位，其流行病学已发生变化。我们报告入住综合重症监护病房（ICU）的CS患者的流行病学情况及预后。
一项前瞻性多中心流行病学研究，纳入了2011年至2018年期间314家遵循GiViTI全国登记系统的综合ICU，排除心脏骤停患者。该研究的主要终点是死亡率。使用逻辑回归模型评估临床因素与死亡率之间的关联。协变量的比值比（OR）量化了它们与住院期间死亡率的关联。共有11052名入住综合ICU的CS患者被纳入研究{发病率2.17%；中位年龄72岁[四分位间距（66 - 81）]，38.7%为女性}。47%的患者在入院时存在三个以上器官功能不全。最常见的CS病因是左心衰竭（LHF，5247例 - 47.5%）；急性心肌梗死（3612例 - 32.6%）；右心衰竭（RHF，515例 - 4.6%）；以及双心室衰竭（532例 - 4.8%）。在ICU住院期间，共有85.5%的患者接受了机械通气。ICU总体死亡率为44.8%，在索引医院住院期间升至53.4%，在最新医院升至54.3%。右心衰竭 - 心源性休克患者表现出最高的死亡风险[OR：1.19，95%置信区间（CI）（0.94 - 1.50）；P < 0.001]，其次是双心室CS[OR 1.04，95% CI（0.82 - 1.32）]。呼吸衰竭[OR 1.13（95% CI 1.08 - 1.19）]、凝血障碍[1.17（95% CI 1.1 - 1.24）]、肾功能不全[OR 1.55（95% CI 1.50 - 1.61）]和神经功能改变[OR 1.45（95% CI 1.39 - 1.50）]与预后恶化相关，同时严重低血压[收缩压 < 70 mmHg - OR 2.35，95% CI（2.06 - 2.67）]、年龄增加[OR 2.21 95% CI（2.01 - 2.42）]以及入院前在ICU停留时间较长（每4.7天增加一倍）也与预后恶化相关。
在综合ICU中，排除心脏骤停后，CS的病因仍主要以LHF为特征，RHF - CS的死亡率更高。入院时多器官功能衰竭以及在入住ICU前住院时间较长易导致预后恶化。
