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Published on: March 22, 2024
Hemoglobin in cardiogenic shock: the lower, the poorer survival
Miloud Cherbi1,2, Bruno Levy3, Hamid Merdji4
1Intensive Cardiac Care Unit, University Hospital of Toulouse, Toulouse, France. cherbi.miloud@gmail.com.
Insights
Anemia significantly increases mortality in cardiogenic shock (CS) patients. Lower hemoglobin levels correlate with higher short-term and long-term death rates, highlighting the need for further research into transfusion strategies.
Area of Science:
- Cardiology
- Critical Care Medicine
- Hematology
Background:
- Cardiogenic shock (CS) is a critical condition with high mortality rates.
- The impact of anemia on CS outcomes remains largely unexplored.
- This study investigates the relationship between hemoglobin levels and CS patient outcomes.
Purpose of the Study:
- To determine the effect of admission hemoglobin levels on short-term and long-term mortality in patients with cardiogenic shock.
- To analyze the association between anemia and the need for interventions like renal replacement therapy and vasopressors.
Main Methods:
- Prospective registry (FRENSHOCK) including 772 CS patients from 49 centers.
- Analysis of one-month and one-year mortality based on admission hemoglobin quartiles.
- Multivariate Cox regression to adjust for baseline characteristics.
Main Results:
- Among 754 patients, 47.9% had anemia (Hb < 11.0 g/dL).
- Anemia (lowest quartile) was associated with increased need for renal replacement therapy and norepinephrine.
- A significant trend of increasing all-cause mortality was observed across decreasing hemoglobin quartiles at 1 month (Ptrend=0.035) and 1 year (Ptrend<0.01).
- Patients in the lowest Hb quartile had 1.64 times higher 1-month mortality and 2.53 times higher 1-year mortality compared to the highest quartile.
Conclusions:
- Anemia is prevalent in CS and significantly worsens both short- and long-term mortality.
- The negative impact of low hemoglobin on mortality was confirmed in multivariate analysis.
- Further randomized trials are needed to elucidate mechanisms and optimize transfusion strategies in CS patients with anemia.
Background:
Cardiogenic shock (CS) is a severe hemodynamic condition with high mortality. Although extremely frequent in daily practice, the impact of anemia in CS is largely unknown. This study focuses on the consequences of low hemoglobin (Hb) level on the outcomes of CS patients.
Methods:
FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. One-month and one-year mortalities were analyzed according to the admission level of Hb.
Results:
Among 754 patients, 71.8% were male, with a mean age of 65.8 (± 14.8) years, and 361 (47.9%) presenting with anemia. Four groups were defined, depending on admission Hb levels by quartiles: Q1: Hb < 11.0 g/dL, Q2: Hb 11-12.6 g/dL, Q3: Hb > 12.6-14 g/dL, and Q4: Hb > 14.0 g/dL. Patients from the Q1 group required more frequent renal replacement therapy and norepinephrine. A significant increase in all-cause mortality was observed across Hb quartiles at 1 month (Ptrend = 0.035) and 1 year (Ptrend < 0.01). Q1 patients had 1.64 times higher mortality at 1 month (1.09-2.47, p = 0.02) and 2.53 times higher mortality at 1 year (1.84-3.49, p < 0.01) compared to Q4. The negative effect of low Hb level was confirmed in multivariate Cox regression adjusted for baseline characteristics, and was stronger in men, non-ischemic CS, patients without CKD and patients aged < 67 years.
Conclusion:
Anemia is a common condition frequently intertwined with CS worsening both short- and long-term mortality. Further randomized studies are warranted to understand its mechanisms and adapt the transfusion strategy.
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