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Mortality predictors, in the first 24 hours, in patients admitted in Non-cardiac Intensive Care Unit with Cardiogenic Shock
1Hospitalar Center Barreiro-Montijo - Lisboa - Portugal
2Hospital Center of Tras-os-Montes and Alto Douro, Intensive Medicine - Vila Real - Portugal
Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion due to primary cardiac dysfunction. Most epidemiological data for CS focus on patients with acute myocardial infarction managed in intensive care units (ICUs) of cardiology departments.
Identify main predictors of mortality in a general ICU, in the first 24h of cardiogenic shock, and evaluate their impact in the outcome.
Retrospective analysis of patients (P) admitted in our ICU, with confirmed diagnosis of CS, within a period of 5 years (January 2012- December 2016). We analyzed common epidemiological variables, evolution during ICU stay, established therapeutics and outcome.
90 P were included. The mean age of the population was 69,59 ± 12,23 years, with a predominance of males (56,7%). Majority of P coming from the Emergency Room (45,6%) and 26,7% presenting cardiopulmonary arrest at admission. Admission SOFA of 10,39 ± 3,19. The main cause of CS (defined by clinical and echo evaluation) was non-ischemic (66,7%). In 27,8% of P the presence of mixed shock was verified. 68,9% needed mechanical invasive ventilation in the first 24h. Maximum PEEP of 8,22± 2,76 and median weaning of 3 days during ICU stay, respectively. PaO2/FiO2 ratio and lactactes at admission of 178,5 and 2,85, respectively. All the patients needed aminergic support. 34,4% needed renal replacement therapy.
At discharge, the patients presented median ICU stay of 5 days with SOFA, APACHE II and SAPS II of 7.6±5,06, 24,5 and 56,61 ± 19,71, respectively. Hospital mortality of 45,6%.
We found a statistically significant association between outcome and: admission SOFA (p=0,006), APACHE II (p<0,001), etiology (p=0,024) and variation (v) of lactates in the first 24h (p=0,027). We also point out that after applying a logistic regression, only APACHE II (OR: 1,12; IC95%: ,049-1,196) and v24h lactates (OR 0,811; IC95%: 0,672-0,979) had relevant prediction power.
CS requires rapid diagnosis and appropriate therapy to have a positive influence on the outcome. In our study, we found that APACHE II and v24h lactates were the best predictors of mortality.
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