title: Predictors of in-hospital mortality among cardiogenic shock patients. Prognostic and therapeutic implications.
abstract: BACKGROUND
  Cardiogenic shock (CS) has a poor prognosis. The heterogeneity in the mortality through different subgroups suggests that some factors can be useful to perform risk stratification and guide management. We aimed to find predictors of in-hospital mortality in these patients.
  
  
  METHODS
  We analyzed all cases of cardiogenic shock due to medical conditions admitted in our intensive acute cardiovascular care unity from November 2010 till November 2015. Clinical, biochemical and hemodynamic variables were registered, as was the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile at 24h of CS diagnosis. From a total of 281 patients, 28 died within the first 24h and were not included in the analysis.
  
  
  RESULTS
  A total of 253 patients survived the first 24h, mean age was 68.8±14.4years, and 174 (68.8%) were men. Etiologies: acute coronary syndrome 146 (57.7%), acute heart failure 60 (23.7%), arrhythmias 35 (13.8%), and others 12 (4.8%). A total of 91 patients (36.0%) died during hospitalization. We found the following independent predictors of in-hospital mortality: age (odds ratio [OR] 1.032, 95% confidence interval [CI] 1.003-1.062), blood glucose (OR 1.004, 95% CI 1.001-1.008), heart rate (OR 1.014, 95% CI 1.001-1.028), and INTERMACS profile (OR 0.168, 95% CI 0.107-0.266).
  
  
  CONCLUSIONS
  In patients with CS the INTERMACS profile at 24h of diagnosis was associated with higher in-hospital mortality. This and other prognostic variables (age, blood glucose, and heart rate) may be useful for risk stratification and to select appropriate medical or invasive interventions.
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Iago
authors.initials: I
authors.lastname: Sousa-Casasnovas
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Devesa
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Juárez
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Spain; Universidad Europea de Madrid, Spain. Electronic address: mmselles@secardiologia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Sellés
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001243:Assisted Circulation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D019468:Disease Management; D005260:Female; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors
keywords: Cardiogenic shock; INTERMACS; Management; Prognosis