Admission diagnosis and mortality risk prediction in a contemporary cardiac intensive care unit population

Introduction: Acute kidney injury (AKI) is a highly prevalent risk factor for mortality among patients with cardiogenic shock (CS). We sought to assess the incidence and prognostic relevance of AKI as a function of shock severity in unselected Cardiac Intensive Care Unit (CICU) patients, as measured by the Society for the Cardiovascular Angiography and Interventions (SCAI) shock stage. Methods: We retrospectively reviewed admissions to the Mayo Clinic from 2007 to 2015 and stratified patients by the SCAI shock stage. AKI was defined and staged based on changes in serum creatinine during hospitalization as per KDIGO guidelines. Predictors of in-hospital mortality were analyzed using Kaplan-Meier survival analysis, and one-year mortality was analyzed using Cox proportional-hazards analysis. Results: The final study population included 10,004 unique patients with a mean age of 67 years and 37% females. The percentage of patients with SCAI shock stages A, B, C, D, and E were 47%, 30%, 15%, 7%, and 1%, respectively. AKI of any severity occurred in 51% of patients during hospitalization, including severe (stage 2/3) AKI in 16%. The incidence of AKI and severe AKI increased with the SCAI shock stage. Hospital mortality occurred in 8% of patients and increased as a function of the AKI stage and SCAI shock stage. AKI was associated with increased hospital mortality after multivariable adjustment (adjusted OR per AKI stage 1.17, 95% CI 1.05-1.30, p=0.005). Twenty-one percent of patients died within one year of CICU admission, and worse AKI was associated with increased one-year mortality (adjusted HR per AKI stage 1.11, 95% CI 1.05-1.18, p=<0.001). Hospital survivors with AKI of any severity had higher mortality compared with patients who did not have AKI (p<0.001). Conclusions: AKI was increasingly common in CICU patients with higher shock severity. In-hospital and one-year mortality risk increased as a function of the severity of AKI and the SCAI shock stage. This analysis emphasizes the importance of AKI as a complication of shock and as a predictor of adverse outcomes in CICU patients.

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CAN THE SEQUENTIAL ORGAN FAILURE ASSESSMENT (SOFA) SCORE BE USED FOR RISK STRATIFICATION IN A TERTIARY CARDIAC INTENSIVE CARE UNIT POPULATION?

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31678-8 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1051

Author(s):

Anika Raja ◽

Ankit Vyas ◽

Aaron Jacob Bagnola ◽

Scott Barnett ◽

Carolyn Rosner ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Risk Stratification ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Sofa Score ◽

Cardiac Intensive Care Unit ◽

Intensive Care Unit Population ◽

Failure Assessment ◽

Cardiac Intensive Care

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Admission Society for Cardiovascular Angiography and Intervention shock stage stratifies post-discharge mortality risk in cardiac intensive care unit patients

American Heart Journal ◽

10.1016/j.ahj.2019.10.012 ◽

2020 ◽

Vol 219 ◽

pp. 37-46 ◽

Cited By ~ 9

Author(s):

Jacob C. Jentzer ◽

David A. Baran ◽

Sean van Diepen ◽

Gregory W. Barsness ◽

Timothy D. Henry ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Risk ◽

Post Discharge ◽

Cardiac Intensive Care Unit ◽

Cardiac Intensive Care

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Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population

Journal of the American Heart Association ◽

10.1161/jaha.117.008169 ◽

2018 ◽

Vol 7 (6) ◽

Cited By ~ 42

Author(s):

Jacob C. Jentzer ◽

Courtney Bennett ◽

Brandon M. Wiley ◽

Dennis H. Murphree ◽

Mark T. Keegan ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sequential Organ Failure Assessment ◽

Organ Failure ◽

Predictive Value ◽

Cardiac Intensive Care Unit ◽

Intensive Care Unit Population ◽

Assessment Score ◽

Failure Assessment ◽

Cardiac Intensive Care

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Defining Shock and Preshock for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients

Circulation Heart Failure ◽

10.1161/circheartfailure.120.007678 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Jacob C. Jentzer ◽

Barry Burstein ◽

Sean Van Diepen ◽

Joseph Murphy ◽

David R. Holmes ◽

...

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Mortality Risk ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cardiac Intensive Care Unit ◽

Coronary Syndrome ◽

Cardiac Intensive Care

Background: Previous studies have defined preshock as isolated hypotension or isolated hypoperfusion, whereas shock has been variably defined as hypoperfusion with or without hypotension. We aimed to evaluate the mortality risk associated with hypotension and hypoperfusion at the time of admission in a cardiac intensive care unit population. Methods: We analyzed Mayo Clinic cardiac intensive care unit patients admitted between 2007 and 2015. Hypotension was defined as systolic blood pressure <90 mm Hg or mean arterial pressure <60 mm Hg, and hypoperfusion as admission lactate >2 mmol/L, oliguria, or rising creatinine. Associations between hypotension and hypoperfusion with hospital mortality were estimated using multivariable logistic regression. Results: Among 10 004 patients with a median age of 69 years, 43.1% had acute coronary syndrome, and 46.1% had heart failure. Isolated hypotension was present in 16.7%, isolated hypoperfusion in 15.3%, and 8.7% had both hypotension and hypoperfusion. Stepwise increases in hospital mortality were observed with hypotension and hypoperfusion compared with neither hypotension nor hypoperfusion (3.3%; all P <0.001): isolated hypotension, 9.3% (adjusted odds ratio, 1.7 [95% CI, 1.4–2.2]); isolated hypoperfusion, 17.2% (adjusted odds ratio, 2.3 [95% CI, 1.9–3.0]); both hypotension and hypoperfusion, 33.8% (adjusted odds ratio, 2.8 [95% CI, 2.1–3.6]). Adjusted hospital mortality in patients with isolated hypoperfusion was higher than in patients with isolated hypotension ( P =0.02) and not significant different from patients with both hypotension and hypoperfusion ( P =0.18). Conclusions: Hypotension and hypoperfusion are both associated with increased mortality in cardiac intensive care unit patients. Hospital mortality is higher with isolated hypoperfusion or concomitant hypotension and hypoperfusion (classic shock). We contend that preshock should refer to isolated hypotension without hypoperfusion, while patients with hypoperfusion can be considered to have shock, irrespective of blood pressure.

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