UNLOADERS-PVAD Weaning Score: predicting post-weaning adverse events in cardiogenic shock patients supported by...

Limited data are available on risk stratification in patients undergoing weaning from percutaneous ventricular assist devices (PVADs). We aimed to identify factors associated with adverse events following PVAD weaning and to construct a predictive scoring system.

This study was a secondary analysis of the UNLOADERS-PVAD study, an observational registry involving three participating institutions in Japan. Consecutive patients with cardiogenic shock who received PVAD support were analyzed for 13 clinical and nine hemodynamic factors assessed immediately prior to PVAD explantation, using the least absolute shrinkage and selection operator (LASSO) method. Risk factors associated with 30-day events, defined as all-cause mortality or reintroduction of mechanical circulatory support after PVAD weaning, were identified.

Among 304 patients, four clinical factors (female sex, renal replacement therapy, use of multiple vasopressors and/or inotropes, and elevated lactate levels) and three hemodynamic factors (elevated heart rate, elevated pulmonary artery wedge pressure, and lower cardiac power output) immediately prior to PVAD explantation were selected to construct a predictive scoring system for 30-day event risk. This score stratified 30-day event risk linearly and demonstrated good predictive accuracy (area under the curve: 0.786; 95% CI 0.712-0.860).

Four clinical and three hemodynamic factors were significantly associated with 30-day events following PVAD weaning, leading to the development of the UNLOADERS-PVAD Weaning Score. This scoring system facilitates accurate risk stratification before PVAD weaning, guiding clinical decisions regarding further interventions.

UMIN000052966.