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Morici N, Viola G, Antolini L, Alicandro G, Dal Martello M, Sacco A, Bottiroli M, Pappalardo F, Villanova L, De Ponti L, La Vecchia C, Frigerio M, Oliva F, Fried J, Colombo P, Garan AR. Predicting survival in patients with acute decompensated heart failure complicated by cardiogenic shock. IJC HEART & VASCULATURE 2021; 34:100809. [PMID: 34141863 PMCID: PMC8188054 DOI: 10.1016/j.ijcha.2021.100809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/15/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022]
Abstract
Background Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS. Methods and results Using logistic regression, univariable testing was performed to identify the variables potentially associated with 28-day mortality. We propose a new logistic model (ALC-Shock score) based on three easy parameters (age, serum creatinine and serum lactate at the ICU admission) as a powerful predictor of survival or successful bridge to heart replacement therapy at 28-day follow-up in this specific population. A multivariable analysis (logistic model) was performed to evaluate the association between selected variables and outcome (overall death at 28-day follow up). The score was then validated in a different cohort of 93 ADHF-CS patients and compared to a previous developed score (the Cardshock score).Overall, 28-day mortality was 34%. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73-0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55-0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66. Conclusions A simple score including age, lactates and creatinine on admission could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification.
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Affiliation(s)
- Nuccia Morici
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Viola
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Antolini
- School of Medicine, Center of Bioststistics for Clinical Epidemiology, Univ. Milano Bicocca, Monza, Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Michela Dal Martello
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alice Sacco
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maurizio Bottiroli
- Cardio-thoracic Intensive Care Unit and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Luca Villanova
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura De Ponti
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Maria Frigerio
- Heart Failure and Cardiac Transplant Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Oliva
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Justin Fried
- Division of Cardiology, Department of Medicine, Columbia University Medical Center-New York Presbyterian, NewYork, NewYork, USA
| | - Paolo Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center-New York Presbyterian, NewYork, NewYork, USA
| | - Arthur Reshad Garan
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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