Rusnak Jonas, Schupp Tobias, Weidner Kathrin, Ruka Marinela, Egner-Walter Sascha, Schmitt Alexander, Akin Muharrem, Tajti Péter, Mashayekhi Kambis, Ayoub Mohamed, Behnes Michael, Akin Ibrahim
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.
Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany.
Rev Cardiovasc Med. 2024 Nov 22;25(11):420. doi: 10.31083/j.rcm2511420. eCollection 2024 Nov.
There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS.
Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry. Our study evaluated the prognostic influence of lung compliance on 30-day all-cause mortality. Statistical analyses comprised -tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman's correlation, Kaplan-Meier survival analyses, and Cox regression.
A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmHO) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmHO demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmHO was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085-2.659; = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952-2.438; = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days ( = 0.003).
In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days.
NCT05575856, https://clinicaltrials.gov/study/NCT05575856.
关于肺顺应性对心源性休克（CS）患者预后的影响，相关数据有限。因此，开展了一项注册研究，以评估肺顺应性对接受有创通气的CS患者的预后影响。
收集了2019年6月至2021年5月期间连续接受有创通气的CS患者的医院记录，并纳入一项前瞻性注册研究。我们的研究评估了肺顺应性对30天全因死亡率的预后影响。统计分析包括t检验、方差分析（ANOVA）、Kruskal-Wallis检验、Spearman相关性分析、Kaplan-Meier生存分析和Cox回归分析。
总共纳入了141例需要有创机械通气的CS患者。按四分位数分层显示，肺顺应性最低（≤23.8 mL/cmH₂O）的患者总体及心搏骤停的CS患者亚组中的死亡率最高（分别为77.1%对66.7%对48.6%对51.4%；对数秩检验P = 0.018）（80%对74%对53%对59%；对数秩检验P = 0.037）。按中位数分层后，肺顺应性<30.4 mL/cmH₂O的患者在总体队列和心搏骤停亚组中的30天全因死亡率均显著高于该阈值以上的患者（分别为71.8%对50.0%；对数秩检验P = 0.007）（77.2%对55.9%；对数秩检验P = 0.008）。多变量调整证实，肺顺应性<30.4 mL/cmH₂O与整个队列中30天全因死亡率增加显著相关（风险比[HR] = 1.698；95%置信区间1.085 - 2.659；P = 0.021）。值得注意的是，在有心搏骤停的CS患者中这种关联不显著（HR = 1.523；95%置信区间0.952 - 2.438；P = 0.080）。此外，肺顺应性低于中位数的患者无呼吸机天数更少（P = 小0.003）。
在接受有创通气的CS患者中，低肺顺应性与较高的全因死亡率和30天时较少的无呼吸机天数相关。
NCT05575856，https://clinicaltrials.gov/study/NCT05575856 。
