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Mortality risk prediction in elderly patients with cardiogenic shock: results from the CardShock study
Mari Hongisto1, Johan Lassus2, Tuukka Tarvasmäki2
1Division of Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, PO Box 900, Helsinki, 00029 HUS, Finland.
Insights
Elderly patients with cardiogenic shock face higher in-hospital mortality but achieve similar long-term survival. Biomarkers like growth differentiation factor-15 (GDF-15) and soluble ST2 (sST2) enhance risk prediction beyond current scores.
Area of Science:
- Cardiology
- Geriatric Medicine
- Biomarker Research
Background:
- Cardiogenic shock in elderly patients presents unique challenges.
- Understanding age-specific risk factors and outcomes is crucial for effective management.
- Contemporary clinical risk scores may have limitations in predicting mortality in older populations.
Purpose of the Study:
- To evaluate the effectiveness of current clinical risk scores in elderly patients with cardiogenic shock.
- To investigate the potential of growth differentiation factor-15 (GDF-15) and soluble ST2 (sST2) biomarkers to improve risk prediction.
- To compare outcomes between elderly and younger patients experiencing cardiogenic shock.
Main Methods:
- Analysis of 219 patients from the multicentre CardShock study, stratified by age (≥75 years vs. younger).
- Comparison of patient characteristics, management strategies, and outcomes between age groups.
- Assessment of the predictive accuracy of the CardShock and IABP-SHOCK II risk scores, and the added value of GDF-15 and sST2 for in-hospital mortality in the elderly.
Main Results:
- Elderly patients (26% of cohort) were more likely to be female and have comorbidities.
- While in-hospital mortality was higher in the elderly (46% vs. 33%), 1-year post-discharge survival was comparable (90% vs. 88%).
- Risk scores showed moderate predictive ability (AUC 0.71-0.75), significantly improved by incorporating GDF-15 and sST2 (AUC 0.78-0.84) in the elderly.
Conclusions:
- Elderly patients with cardiogenic shock experience higher in-hospital mortality but similar long-term survival compared to younger individuals.
- Established risk scores are valuable for predicting early mortality in this demographic.
- Integrating biomarkers such as GDF-15 and sST2 offers a promising avenue for enhanced risk stratification in elderly patients with cardiogenic shock.
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.
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