Related Experiment Videos
Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study
Anu Kataja1, Tuukka Tarvasmäki1, Johan Lassus2
11 Division of Emergency Medicine, University of Helsinki, Helsinki University Hospital, Finland.
Insights
Altered mental status is common in cardiogenic shock, affecting 68% of patients. This sign of hypoperfusion is linked to higher mortality and is independently associated with low arterial pH.
Area of Science:
- Cardiology
- Critical Care Medicine
- Neurology
Background:
- Altered mental status is a recognized sign of hypoperfusion in cardiogenic shock, a critical manifestation of acute heart failure.
- Understanding the prevalence, associated factors, and prognostic implications of altered mental status in cardiogenic shock is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of altered mental status in patients with cardiogenic shock.
- To identify clinical and biochemical factors associated with altered mental status.
- To evaluate the prognostic significance of altered mental status in cardiogenic shock outcomes.
Main Methods:
- A multinational, prospective, observational study involving 215 adult patients with cardiogenic shock.
- Assessment of mental status upon presentation.
- Comparison of clinical, biochemical, and short-term mortality data between patients with altered and normal mental status.
Main Results:
- Altered mental status was observed in 147 (68%) patients.
- Patients with altered mental status were older and more likely to have acute coronary syndrome.
- Associated factors included lower systolic blood pressure, lower arterial pH, higher blood lactate, and higher blood glucose; low arterial pH was independently associated.
Conclusions:
- Altered mental status is a frequent indicator of systemic hypoperfusion in cardiogenic shock, correlating with adverse outcomes.
- Biochemical markers of inadequate tissue perfusion, particularly low arterial pH, are linked to altered mental status.
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.