The short-term prognosis of cardiogenic shock can be determined using hemodynamic variables: a retrospective cohort study. (Dugan)

Rigamonti F, Graf G, Merlani P, Bendjelid K. The short-term prognosis of cardiogenic shock can be determined using hemodynamic variables: a retrospective cohort study*. Crit Care Med. 2013 Nov;41(11):2484-91.

OBJECTIVES: Few reports address the relationship between hemodynamic variables and the cardiogenic shock outcome in critically ill patients. The present study aimed to investigate the association between hemodynamic variables and early cardiogenic shock mortality in critically ill patients.

DESIGN: Retrospective, single-center cohort study.

SETTING: Tertiary academic hospital’s 36-bed multidisciplinary intensive care.

PATIENTS: Initial presentation with cardiogenic shock.

MEASUREMENTS AND MAIN RESULTS: The authors retrospectively analyzed medical information and the hemodynamic variables (recorded during the first 24 hr following admission to the ICU) of patients with cardiogenic shock. For all the patients, the Simplified Acute Physiology Score II, cardiac index, cardiac power index, and continuous hemodynamic values following the first 24 hours of admission were reviewed. Mortality within 28 days was the primary endpoint. All the variables were then compared with survival and nonsurvival status and those variables with a significant association in the univariate analysis were entered into a multivariate logistic regression model. Seventy-one patients were included. Among them, 26 (37%) died within 28 days after ICU admission and were classified as “nonsurvivors.” The minimum value for diastolic arterial blood pressure during the first 24 hours was independently associated with the 28-day mortality in the univariate and multivariate analyses model. This model performed better than the model using the Simplified Acute Physiology Score II, even when assessing the effect of inotrope and vasoactive treatments at 24, 48, and 72 hours.

CONCLUSIONS: In the first 24 hours of an ICU admission, the minimum diastolic arterial blood pressure was a hemodynamic variable that was independently associated with 28-day mortality in cardiogenic shock patients.

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