Clinical phenotyping of cardiogenic shock at a glance: A rapid, costless, streamlined approach

Cardiogenic shock (CS) is a heterogeneous syndrome in which recent guidelines have proposed clinical phenotyping based on the presence of hypoperfusion and/or congestion signs and symptoms. However, the impact of this clinical phenotype on outcomes remains poorly characterized.

FRENSHOCK is a prospective registry including 772 CS patients from 49 centres. Patients were categorized into multiple phenotypic groups based on three clinically assessed bedside criteria at admission: congestion, hypotension and skin mottling. The primary endpoint was 30-day all-cause mortality. Among 475 CS patients included, 69.7% were male, with a median age of 67.0 (59.0-78.0) years. Most patients presented with SCAI stage C (37.1%) or D (51.2%). At admission, 424 patients (89.3%) presented with congestion (50.7% on both sides, 39.2% left-sided, 10.1% right-sided), 343 (72.2%) with hypotension and 180 (37.9%) with mottling. At 30 days, 113 patients (23.8%) had died, spanning from 8.8% for patients with isolated hypotension (without congestion/mottling) to 26.5% for patients with hypotension and congestion, and 32.3% for patients with hypotension, congestion and mottling. The corresponding ORs for 30-day all-cause mortality remained significant even after adjustment for potential confounders, with 1.19 [(1.02-1.39), P = 0.03] for hypotension and congestion and 1.26 [(1.08-1.48), P < 0.01] for hypotension, congestion and mottling.

A simple clinical bedside evaluation of the CS phenotype based on hypotension, congestion and mottling allows for quick and costless stratification of 30-day mortality risk and can be used to guide the level of monitoring intensity and/or patient management.