title: Cardiogenic shock in intensive care units: evolution of prevalence, patient profile, management and outcomes, 1997-2012.
abstract: To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years.
  
  
  
  From the 1997-2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes [Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality] and predictors of in-ICU mortality. Of the 316 905 ICU admissions, 19 416 (6.1%) exhibited CS, with incidence increasing from 4.1% to 7.7% (P < 0.001). Over time, the age of admitted patients decreased by 2.7 years [95% confidence interval (CI), -2.0 to -3.4] and SAPS-II increased by 5.8% (95% CI 4.8-6.8) from 58.7 ± 25.3 to 64.5 ± 23.3 (P < 0.001). Crude in-ICU mortality declined from 50% to 45% (-5.6%; 95% CI -7.7 to -3.5) as SAPS-II Standardized ICU mortality rates decreased from 56.5% to 44.2% (P < 0.001). A more recent time-period was an independent correlate of decreased mortality in multivariate analyses. The decrease in mortality rate was more marked in patients with decompensated heart failure, cardiac arrest, or acute myocardial infarction.
  
  
  
  Patients with CS represent a greater proportion of patients admitted to ICUs over the past 15 years, having become younger but more critically ill. Although their mortality has decreased, suggesting improved overall patient management, it remains particularly high, warranting further research specifically focused on this population.
authors.affiliation: Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Cardiologie, and Université Paris 5, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Intensive Care Unit and Université Paris 5, Paris, France.
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Fagon
authors.affiliation: AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique et Département de Santé Publique, Boulogne Billancourt, France.|UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France.|INSERM, U1168 VIMA, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Intensive Care Unit and Université Paris 5, Paris, France.
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Diehl
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Intensive Care Unit and Université Paris 5, Paris, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Monnier
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Intensive Care Unit and Université Paris 5, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Hauw-Berlemont
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Intensive Care Unit and Université Paris 5, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Boissier
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Unité de Recherche Clinique and Centre d'Investigation Epidémiologique 4, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.affiliation: AP-HP, Hôpital Saint Antoine, Intensive Care Unit and INSERM U444, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Cardiologie, and Université Paris 5, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Intensive Care Unit and Université Paris 5, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002395:Catecholamines / Q000627:therapeutic use; D016208:Databases, Factual; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D006323:Heart Arrest / Q000150:complications / Q000453:epidemiology*; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology*; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data; D011158:Population Growth; D015995:Prevalence; D011379:Prognosis; D000091402:Prohibitins; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012770:Shock, Cardiogenic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy
chemical_list: D002395:Catecholamines; C000717331:PHB2 protein, human; D000091402:Prohibitins
keywords: Cardiogenic shock; Epidemiology; Intensive care unit; Mortality; Simplified Acute Physiology Score