Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model.

Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. METHODS: Observational unicentric study of a cohort of CS patients. SOFA, SAPS II and APACHE II scores were calculated in the first 24 h of CCU admission. RESULTS: 130 patients with CS were included. SOFA, SAPS II and APACHE II scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; P = .6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases. Acute coronary syndrome, lactate serum values, SAPS II score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). CONCLUSION: In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.

Utilidad de las escalas de gravedad en la predicción de mortalidad intrahospitalaria en el shock cardiogénico. Propuesta de un nuevo modelo pronóstico / Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model

El shock cardiogénico (SC) es una entidad que comprende múltiples etiologías y asocia elevada mortalidad. Algunas escalas de gravedad han demostrado ser buenos predictores de mortalidad hospitalaria en pacientes ingresados en Unidades de Cuidados Intensivos (UCI). El objetivo principal de este estudio es analizar su utilidad y validez en una cohorte de pacientes en SC. Métodos: Estudio observacional unicéntrico. Se calcularon las escalas SOFA, SAPSII y APACHEII en las primeras 24horas de ingreso en UCI. Resultados: Se incluyeron 130 pacientes con SC. Las escalas SOFA, SAPSII y APACHEII mostraron buena discriminación para la mortalidad hospitalaria, obteniendo valores de área bajo la curva (AUC) ROC similares (AUC: 0,711, 0,752 y 0,742, respectivamente; p=0,6). La calibración, estimada por el test de Hosmer-Lemeshow, fue adecuada en todos los casos, SOFA (p=0,787), SAPSII (p=0,078) y APACHEII (p=0,522). Resultaron: predictores independientes de mortalidad intrahospitalaria: el síndrome coronario agudo (SCA), los valores de lactato sérico, el SAPSII y el índice de vasoactivos inotrópicos (VIS) en las primeras 24horas de ingreso en UCI.Con estas variables se desarrolló un indicador pronóstico específico para el SC (SAPS-2-LIVE) que mejora la capacidad predictiva de mortalidad en nuestra serie (AUC) ROC, 0,825 (IC 95% 0,752-0,89). Conclusión: En esta cohorte contemporánea de SC, las escalas SOFA, SAPSII y APACHEII han demostrado una buena capacidad de predicción de mortalidad hospitalaria. Estos hallazgos podrían contribuir a una mejor estratificación del riesgo en el SC.(AU)

Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. Methods: Observational unicentric study of a cohort of CS patients. SOFA, SAPSII and APACHEII scores were calculated in the first 24hours of CCU admission. Results: 130 patients with CS were included. SOFA, SAPSII and APACHEII scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; p=0.6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases.Acute coronary syndrome, lactate serum values, SAPSII score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). Conclusion: In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.(AU)