Serial Assessment of Shock Severity in Cardiac Intensive Care Unit Patients

Area of Science:

• Cardiology
• Intensive Care Medicine
• Clinical Risk Stratification

Background:

• The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification is a validated tool for mortality prediction in cardiac intensive care units (CICUs).
• Previous studies focused on one-time assessments, leaving the utility of serial assessments for risk stratification unexplored.

Purpose of the Study:

• To evaluate whether serial assessments of the SCAI shock classification can enhance mortality risk stratification in CICU patients.
• To determine if dynamic changes in SCAI shock stage over time provide additional prognostic information.

Main Methods:

• Retrospective cohort study of 2918 unique CICU admissions between 2015 and 2018.
• SCAI shock stage assigned in 4-hour blocks during the initial 24 hours of CICU stay.
• Logistic regression used to assess the association between SCAI shock stage (admission, maximum, mean) and in-hospital mortality.

Main Results:

• Over 52% of patients experienced shock (SCAI stage C, D, or E) during their CICU stay; 9.1% died in-hospital.
• Higher admission, maximum, and mean SCAI shock stages were all incrementally associated with increased in-hospital mortality.
• Each additional 4-hour block meeting shock criteria predicted higher mortality, with the mean SCAI shock stage showing the highest discrimination.

Conclusions:

• Serial assessment of SCAI shock classification provides superior mortality risk stratification compared to a single assessment.
• Quantifying the magnitude and duration of shock through dynamic SCAI staging improves prognostic accuracy in CICU patients.