Mortality risk prediction in elderly patients with cardiogenic shock: results from the CardShock study
Por:
Hongisto, M, Lassus, J, Tarvasmaki, T, Sionis, A, San Rosello, J, Tolppanen, H, Kataja, A, Jantti, T, Sabell, T, Lindholm, MG, Banaszewski, M, Cardoso, JS, Parissis, J, Di Somma, S, Carubelli, V, Jurkko, R, Masip, J, Harjola, VP, CardShock Study In
Publicada:
1 abr 2021
Ahead of Print:
1 ene 2021
Resumen:
Aims This study aimed to assess the utility of contemporary clinical risk scores and explore the ability of two biomarkers [growth differentiation factor-15 (GDF-15) and soluble ST2 (sST2)] to improve risk prediction in elderly patients with cardiogenic shock.
Methods and results Patients (n = 219) from the multicentre CardShock study were grouped according to age (elderly >= 75 years and younger). Characteristics, management, and outcome between the groups were compared. The ability of the CardShock risk score and the IABP-SHOCK II score to predict in-hospital mortality and the additional value of GDF-15 and sST2 to improve risk prediction in the elderly was evaluated. The elderly constituted 26% of the patients (n = 56), with a higher proportion of women (41% vs. 21%, P < 0.05) and more co-morbidities compared with the younger. The primary aetiology of shock in the elderly was acute coronary syndrome (84%), with high rates of percutaneous coronary intervention (87%). Compared with the younger, the elderly had higher in-hospital mortality (46% vs. 33%; P = 0.08), but 1 year post-discharge survival was excellent in both age groups (90% in the elderly vs. 88% in the younger). In the elderly, the risk prediction models demonstrated an area under the curve of 0.75 for the CardShock risk score and 0.71 for the IABP-SHOCK II score. Incorporating GDF-15 and sST2 improved discrimination for both risk scores with areas under the curve ranging from 0.78 to 0.84.
Conclusions Elderly patients with cardiogenic shock have higher in-hospital mortality compared with the younger, but post-discharge outcomes are similar. Contemporary risk scores proved useful for early mortality risk prediction also in the elderly, and risk stratification could be further improved with biomarkers such as GDF-15 or sST2.
Filiaciones:
Hongisto, M:
Helsinki Univ Hosp, Div Emergency Med, Dept Emergency Med & Serv, POB 900, Helsinki 00029, Hus, Finland
Lassus, J:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Tarvasmaki, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Sionis, A:
Univ Autonoma Barcelona, Biomed Res Inst IIB St Pau, Hosp Santa Creu & St Pau, Cardiol Dept,CIBER CV, Barcelona, Spain
San Rosello, J:
Univ Autonoma Barcelona, Biomed Res Inst IIB St Pau, Hosp Santa Creu & St Pau, Cardiol Dept,CIBER CV, Barcelona, Spain
Tolppanen, H:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Kataja, A:
Helsinki Univ Hosp, Div Emergency Med, Dept Emergency Med & Serv, POB 900, Helsinki 00029, Hus, Finland
Jantti, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Sabell, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Lindholm, MG:
Zealand Univ Hosp, Dept Cardiol, Roskilde, Denmark
Banaszewski, M:
Natl Inst Cardiol, Intens Cardiac Therapy Clin, Warsaw, Poland
Cardoso, JS:
Univ Porto, Sao Joao Univ Med Ctr, Dept Cardiol, CINTESIS Ctr Hlth Technol & Serv Res,Fac Med, Porto, Portugal
Parissis, J:
Attikon Univ Hosp, ER & Heart Failure Unit, Athens, Greece
Di Somma, S:
Sapienza Univ Rome, Dept Med Surg Sci & Translat Med, Rome, Italy
Carubelli, V:
Univ Brescia, Dept Med & Surg Specialties, Radiol Sci & Publ Hlth, Cardiol Div, Brescia, Italy
Civil Hosp Brescia, Brescia, Italy
Jurkko, R:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Masip, J:
Univ Barcelona, Hosp St Joan Despi Moises Broggi, Consorci Sanitari Integral, Crit Care Dept, Barcelona, Spain
Harjola, VP:
Helsinki Univ Hosp, Div Emergency Med, Dept Emergency Med & Serv, POB 900, Helsinki 00029, Hus, Finland
gold, Green Published
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