Markart Sebastian, Hermann Alexander, Chiari Florian, Heinz Gottfried, Speidl Walter S, Lenz Max, Hengstenberg Christian, Schellongowski Peter, Staudinger Thomas, Zilberszac Robert
Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2024 Dec 17;13(24):7706. doi: 10.3390/jcm13247706.
: Cardiogenic shock (CS) remains a critical condition with high mortality rates despite advances in treatment. This study aimed to evaluate the prognostic significance of urinary output at various time intervals during CS and its effectiveness as a predictor of 30-day mortality, particularly in comparison to the Simplified Acute Physiology Score 3 (SAPS 3). : We conducted a retrospective analysis of 96 patients diagnosed with CS, assessing urinary output at different intervals (0-6 h, 6-12 h, 12-24 h, and 0-24 h) as potential predictors of 30-day mortality. SAPS 3 was calculated for all patients, and its predictive value was compared to that of urinary output using both univariate and multivariate analyses. Additional analyses included ROC curve assessment and Kaplan-Meier survival analysis. : Urinary output at 6-12 h was significantly associated with 30-day mortality in univariate analysis. Area under the receiver operating characteristic curves (AUROCs) for urinary output at 0-6 h, 6-12 h, and 12-24 h was 0.61 ( = 0.07), 0.63 ( = 0.04), and 0.61 ( = 0.08), respectively. These AUROCs did not differ significantly between the three urinary output parameters. Regarding the cumulative urinary output of 0-24 h, the most pronounced impact was observed in patients producing less than 0.5 mL/kg/h. In multivariate analysis, when combined with SAPS 3, the predictive power of urinary output diminished. SAPS 3 alone demonstrated significant predictive value with an AUROC of 0.77 ( < 0.001). : While early urinary output is a valuable predictor of 30-day mortality in patients with CS, its prognostic strength is limited when considered alongside comprehensive risk assessments like SAPS 3. These findings suggest that a multifaceted approach, incorporating both early and comprehensive indicators, is essential for accurately predicting outcomes in CS patients.
尽管治疗方法有所进步,但心源性休克(CS)仍然是一种死亡率很高的危急病症。本研究旨在评估CS期间不同时间间隔的尿量对预后的意义及其作为30天死亡率预测指标的有效性,特别是与简化急性生理学评分3(SAPS 3)相比。
我们对96例诊断为CS的患者进行了回顾性分析,评估不同时间间隔(0 - 6小时、6 - 12小时、12 - 24小时和0 - 24小时)的尿量作为30天死亡率的潜在预测指标。计算了所有患者的SAPS 3,并使用单因素和多因素分析将其预测价值与尿量的预测价值进行比较。额外的分析包括ROC曲线评估和Kaplan-Meier生存分析。
在单因素分析中,6 - 12小时的尿量与30天死亡率显著相关。0 - 6小时、6 - 12小时和12 - 24小时尿量的受试者工作特征曲线下面积(AUROC)分别为0.61(P = 0.07)、0.63(P = 0.04)和0.61(P = 0.08)。这三个尿量参数的AUROC之间无显著差异。关于0 - 24小时的累积尿量,在尿量小于0.5 mL/kg/h的患者中观察到最明显的影响。在多因素分析中,当与SAPS 3结合时,尿量的预测能力减弱。单独的SAPS 3显示出显著的预测价值,AUROC为0.77(P < 0.001)。
虽然早期尿量是CS患者30天死亡率的有价值预测指标,但与SAPS 3等综合风险评估指标一起考虑时,其预后强度有限。这些发现表明,采用包括早期和综合指标的多方面方法对于准确预测CS患者的预后至关重要。