Beyond Mean Arterial Pressure: Organ Perfusion Pressure as a Hemodynamic Target in Cardiogenic Shock

Current cardiogenic shock (CS) management primarily targets mean arterial pressure (MAP), often overlooking the impact of venous congestion on the effective perfusion gradient. Organ Perfusion Pressure (OPP = MAP - CVP) integrates both. We investigated OPP's prognostic value for mortality, renal function, and resource utilization.

This retrospective cohort study utilized MIMIC-IV database, a single-center, critical care database, to identify adult CS patients. Patients with other forms of shock were excluded. Primary outcomes were in-hospital and ICU mortality. Secondary outcomes included ICU length of stay (LOS), vasopressors/inotropes duration (VID), urine output (UO) over the initial 36 hours, renal replacement therapy (RRT) and invasive mechanical ventilation (IMV). Multivariable models adjusted for demographics (age, sex), comorbidities (Hypertension, diabetes, heart failure, atrial fibrillation, CKD), and shock severity (Cardiac arrest, Vasoactive-Inotropic Score, Maximum lactate) across standardized 12-hour landmarks.

Among 189 patients (mean age 65.3±14.2 years, 65.6% male), prevalent comorbidities included coronary artery disease (52.4%) and HFrEF (50.8%). Acute myocardial infarction was present in 26.5% of cases. Every 5 mmHg increase in 24-hour mean OPP was independently associated with reduced in hospital mortality (aOR 0.79, 95% CI 0.65-0.96, p=0.020). Higher OPP was associated with renal protection, with increased urine output (+0.21 mL/kg/hr, p<0.001) and reduced odds of renal replacement therapy (aOR 0.65, p<0.001).

In CS, a higher OPP is independently associated with improved survival, renal preservation, and resource efficiency. OPP provided incremental value especially for renal outcomes. Prospective interventional trials are mandatory for validation.