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Cardiogenic shock in intensive medicine care: are the old scores still useful?
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. Several clinical and biological factors have been used for prognosis assessment. Those factors have been recently regrouped into scores combining independent parameters—the Sleeper, CardShock and IABP-SHOCK II score, which aren’t used daily in general ICU.
Evaluate usefulness of SOFA, APACHE II and SAPS II scores in predicting the outcome in CS patients (P) and identify the most useful one, if applicable.
Retrospective analysis of P admitted in our ICU, with confirmed diagnosis of CS, within a period of 5 years. We analyzed common epidemiological variables, evolution during ICU stay, established therapeutics and outcome. wE estimated SOFA, APACHE II and SAPS II score at admission and discharge when applicable.
90 P were included. Mean age of 69,59 ± 12,23 years, with a predominance of males (56,7%). Admission SOFA of 10,39 ± 3,19. The main cause of CS was non-ischemic, with only 33,3% caused by acute coronary syndromes. 68,9% needed mechanical invasive ventilation in the first 24h, maximum PEEP used of 8,22±2,76. VCPVG was the most used ventilatory mode, with median weaning time of 3 days. PaO2/FiO2 ratio and lactactes at admission of 178,5 and 2,85, respectively. All the P needed aminergic support. Renal replacement therapy was used in 34,4% P. Step-up and step-down in ICU unit in 6,7 and 26,7% of the cases, respectively. Infectious intercurrence (nosocomial infection) in 35,51% cases. Limitation of the therapeutic effort in 42,22% P.
At discharge, P presented median ICU stay of 5 days (hospital stay of 10,5 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: 1) admission SOFA (p=0,006), 2) APACHE II (p<0,001), 3) SAPS II (p< 0,001). We also point out that after applying a logistic regression only APACHE II (OR: 1,13; IC95%: 1,028-1,253) had relevant prediction power.
In our study, we found that APACHE II was the only score capable of predicting the outcome of our P. It provides an estimate of ICU mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account.
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