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Published on: January 16, 2019
Prognostic performance of the SCAI shock classification at admission and during ICU treatment: A retrospective,
Simone Britsch1, Markward Britsch2, Leonie Hahn3
1Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Centre for Angioscience (ECAS), Medical Faculty Mannheim, German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim and Medical Faculty Mannheim, Heidelberg University, Germany.
Insights
Cardiogenic shock (CS) prognosis improves by tracking the highest Society for Cardiovascular Angiography and Interventions (SCAI) shock stage during intensive care unit (ICU) stay. Monitoring CS evolution offers better outcome prediction than admission-only SCAI staging.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Clinical Prognostics
Background:
- Cardiogenic shock (CS) has high mortality, necessitating accurate prognostic tools.
- The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification stratifies severity and aids outcome prediction.
Purpose of the Study:
- To compare the prognostic performance of SCAI shock classification on admission versus during intensive care unit (ICU) stay.
- To evaluate the predictive value of dynamic CS severity changes for in-hospital mortality.
Main Methods:
- Retrospective analysis of 1303 patients with CS or related conditions (862 included).
- SCAI shock stages assessed on admission and daily for 5 days in the ICU.
- Receiver operating characteristic (ROC) curves used to compare prognostic accuracy for in-hospital mortality.
Main Results:
- On admission, 50.6% had SCAI stage A, with dynamic changes observed during ICU stay.
- Highest SCAI stage during ICU stay (AUC 0.86) and shock evolution (AUC 0.87) showed superior prognostic performance compared to admission SCAI stage (AUC 0.80).
- Statistical significance (p < 0.0001) confirmed improved prediction with dynamic monitoring.
Conclusions:
- SCAI shock stages fluctuate during ICU care, highlighting the need for dynamic assessment.
- Utilizing the highest achieved SCAI shock stage and monitoring CS evolution significantly enhances prognostic accuracy.
- Dynamic assessment of CS severity improves upon reliance solely on admission-stage classification.
Background:
Cardiogenic shock (CS) is characterized by high mortality and requires accurate prognostic tools to predict outcomes and guide treatment. The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification indicates shock severity and can be used for outcome prediction.
Objective:
Here, we compare the prognostic performance of SCAI shock classification determined on admission and during intensive care unit (ICU) stay.
Methods:
We included all patients with CS or conditions associated with developing CS based on ICD codes. SCAI shock stages were determined on admission and during the first 5 days of ICU stay. Receiver operating curves were used to compare the prognostic performance of SCAI stages on admission, SCAI stages during ICU stay and CS evolution (absent, resolved, persistent and new onset) for in-hospital mortality.
Results:
Between 01/2018 and 06/2022, 1303 patients were identified and 862 patients were included. On admission, 50.6 % patients had SCAI shock stage A, 3.9 % SCAI shock stage B, 17.7 % SCAI shock stage C, 7.0 % SCAI shock stage D and 20.8 % SCAI shock stage E. Shock stage distribution changed dynamically during ICU stay. Compared to SCAI stage on admission (AUC 0.80; 95 % CI 0.77-0.83), highest achieved SCAI stage during ICU (AUC 0.86, 95 % CI 0.83-0.89, p < 0.0001) and shock evolution (AUC 0.87, 95 % CI 0.85-0.90, p < 0.0001) yielded better prognostic performance.
Conclusions:
SCAI shock stages changed dynamically during ICU stay, and prognostic performance can be improved by considering highest achieved SCAI shock stage as well as the evolution of CS compared to SCAI shock stage on admission.
