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Mortality predictors, in the first 24 hours, in patients admitted in Non-cardiac Intensive Care Unit with Cardiogenic Shock

Session Poster Session 1

Speaker Hugo Miranda

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : H Miranda (Lisbon,PT), I Milet (Vila Real,PT), N Barros (Vila Real,PT), H Leite (Vila Real,PT), I Militao (Vila Real,PT), F Esteves (Vila Real,PT)

Authors:
H Miranda1 , I Milet2 , N Barros2 , H Leite2 , I Militao2 , F Esteves2 , 1Hospitalar Center Barreiro-Montijo - Lisboa - Portugal , 2Hospital Center of Tras-os-Montes and Alto Douro, Intensive Medicine - Vila Real - Portugal ,

Citation:

Introduction:

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.

Objectives:

Identify main predictors of mortality in a general ICU, in the first 24h of cardiogenic shock, and evaluate their impact in the outcome.

Methods:

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.

Results:

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.

Conclusion

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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