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Predictive Model and Risk Score for In-Hospital Mortality in Patients with All-Cause Cardiogenic Shock
Federico García-Rodeja Arias1,2, Marta Alonso-Fernandez-Gatta3, Marta Pérez Dominguez1,2
1Department of Department, Complejo Hospitalario Universitario de Santiago de Compostela.
Insights
A new Santiago Shock Score (S3) effectively predicts in-hospital mortality in cardiogenic shock (CS) patients. This score aids in stratifying patient risk, guiding clinical decisions for better outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Risk Stratification
Background:
- Cardiogenic shock (CS) presents significant challenges with high morbidity and mortality rates.
- Effective risk stratification is crucial for managing CS patients and optimizing treatment strategies.
Purpose of the Study:
- To develop and validate a novel risk score, the Santiago Shock Score (S3), for predicting in-hospital mortality in patients with cardiogenic shock.
- To compare the predictive accuracy of the S3 score against the existing CardShock score.
Main Methods:
- Retrospective analysis of 135 patients admitted with CS between 2011 and 2020.
- Development of the S3 score using clinical, analytical, and echocardiographic variables at admission.
- Evaluation of the S3 score's predictive performance using the area under the receiver operating characteristic curve (AUC).
Main Results:
- The overall in-hospital mortality rate was 41.5%, with acute coronary syndrome (ACS) as the primary cause in 60.7% of cases.
- The S3 score demonstrated good accuracy in predicting in-hospital mortality (AUC 0.85), outperforming the CardShock score (AUC 0.74).
- Three risk categories (low, intermediate, high) were defined by the S3 score, showing distinct mortality rates (12.9%, 49.1%, 87.5%, respectively).
Conclusions:
- The S3 score exhibits excellent predictive power for in-hospital mortality in non-profound CS patients.
- The S3 score can assist in the initial risk stratification of CS patients.
- Implementation of the S3 score may guide treatment decisions and improve clinical management of CS.
Abstract:
Cardiogenic shock (CS) is a condition associated with high morbidity and mortality. Our study aimed to perform a risk score for in-hospital mortality that allows for stratifying the risk of death in patients with CS.This is a retrospective analysis, which included 135 patients from a Spanish university hospital between 2011 and 2020. The Santiago Shock Score (S3) was created using clinical, analytical, and echocardiographic variables obtained at the time of admission.The in-hospital mortality rate was 41.5%, and acute coronary syndrome (ACS) was the responsible cause of shock in 60.7% of patients. Mitral regurgitation grade III-IV, age, ACS etiology, NT-proBNP, blood hemoglobin, and lactate at admission were included in the score. The S3 had good accuracy for predicting in-hospital mortality area under the receiver operating characteristic curve (AUC) 0.85 (95% confidence interval (CI) 0.78-0.90), higher than the AUC of the CardShock score, which was 0.74 (95% CI 0.66-0.83). Predictive power in a cohort of 131 patients with profound CS was similar to that of CardShock with an AUC of 0.601 (95% CI 0.496-0.706) versus an AUC of 0.558 (95% CI 0.453-0.664). Three risk categories were created according to the S3: low (scores 0-6), intermediate (scores 7-10), and high (scores 11-16) risks, with an observed mortality of 12.9%, 49.1%, and 87.5% respectively (P < 0.001).The S3 score had excellent predictive power for in-hospital mortality in patients with nonprofound CS. It could aid the initial risk stratification of patients and thus, guide treatment and clinical decision making in patients with CS.
