title: Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study.
abstract: BACKGROUND
  Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock.
  
  
  METHODS
  Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status.
  
  
  RESULTS
  Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1-2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status.
  
  
  CONCLUSIONS
  Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.
authors.affiliation: 1 Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland.
authors.forename: Anu
authors.initials: A
authors.lastname: Kataja
authors.affiliation: 1 Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland.
authors.forename: Tuukka
authors.initials: T
authors.lastname: Tarvasmäki
authors.affiliation: 2 Cardiology, University of Helsinki, Heart and Lung Centre, Helsinki University Hospital, Finland.
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.affiliation: 3 Rigshospitalet, Copenhagen University Hospital, Division of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: 4 Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Spain.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sionis
authors.affiliation: 5 Internal Cardiology Department, University Hospital Brno and Masaryk University, Brno, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: 6 Heart Failure Clinic, Attikon University Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: 7 Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carubelli
authors.affiliation: 8 CINTESIS - Centre for Health Technology and Services Research, Department of Cardiology, Faculty of Medicine, University of Porto, São João Medical Centre, Portugal.
authors.forename: Jose
authors.initials: J
authors.lastname: Cardoso
authors.affiliation: 9 Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Banaszewski
authors.affiliation: 10 Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Emergency Department, Sant' Andrea Hospital, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Marino
authors.affiliation: 2 Cardiology, University of Helsinki, Heart and Lung Centre, Helsinki University Hospital, Finland.
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.affiliation: 11 INSERM U942, Hopital Lariboisiere, APHP and University Paris Diderot, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: 1 Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland.
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
mesh_terms: D000368:Aged; D005260:Female; D005387:Finland / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000523:psychology; D015996:Survival Rate / Q000639:trends
keywords: Cardiogenic shock; acidosis; acute coronary syndromes; acute heart failure; altered mental status; delirium