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Published on: June 12, 2021
Risk Stratification in Predicting Cardiogenic Shock 30-Day Mortality admitted to ICU: beyond the Prognostic
Pierre-Grégoire Guinot1,2,3,4, Thomas Hanquiez5, Maxime Nguyen1,2,3,4
1Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France.
Insights
The Shock Academic Research Consortium (SHARC) classification, based on the cause of cardiogenic shock (CS), offers better 30-day mortality prediction in intensive care units (ICUs) than the Society for Cardiovascular Angiography and Interventions (SCAI) staging alone.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Clinical Research
Background:
- Cardiogenic shock (CS) is a significant cause of mortality in intensive care units (ICUs).
- The Shock Academic Research Consortium (SHARC) classification categorizes CS by etiology, complementing severity-based systems like the Society for Cardiovascular Angiography and Interventions (SCAI) classification.
- Understanding etiological factors is crucial for improving CS management and outcomes.
Purpose of the Study:
- To evaluate the association between SHARC classification categories and 30-day mortality in a contemporary ICU population.
- To compare the prognostic value of the SHARC classification with the SCAI classification for 30-day mortality.
- To assess the incremental prognostic value of integrating SHARC and SCAI classifications with clinical and hemodynamic parameters.
Main Methods:
- A bicentric retrospective cohort study included 1366 adult patients admitted with CS.
- Patients were classified into SHARC categories: AMI-CS, HF-CS, secondary-CS, and post-cardiotomy-CS.
- Multivariable logistic regression and model comparison metrics (AIC, BIC, AUC, R² ) were used to assess mortality predictors and prognostic performance.
Main Results:
- Thirty-day mortality significantly differed across SHARC classes, ranging from 48.7% in AMI-CS to 17.3% in post-cardiotomy-CS (p < 0.001).
- SHARC classification, alongside age, vasopressor use, and lactate levels, independently predicted mortality.
- The SHARC classification provided greater incremental prognostic value (AUC=0.734) than SCAI alone (AUC=0.723).
- A combined model integrating SHARC, SCAI, and hemodynamic parameters achieved the highest performance (AUC=0.819).
Conclusions:
- The SHARC etiological classification offers complementary discrimination for 30-day mortality in CS patients compared to SCAI staging alone.
- Shock pathophysiology, as defined by SHARC, significantly influences patient outcomes.
- Integrating both SHARC and SCAI classifications can enhance risk stratification and personalize therapeutic strategies for CS management.
Background:
Cardiogenic shock (CS) remains a leading cause of mortality in intensive care units (ICU) despite advances in management. The Shock Academic Research Consortium (SHARC) classification provides an etiological framework complementing severity-based systems such as the Society for Cardiovascular Angiography and Interventions (SCAI) classification. This study evaluated the association between SHARC classes and 30-day mortality in a contemporary ICU population and compared their prognostic value with SCAI classification.
Methods:
This bicentric retrospective cohort study included 1366 consecutive adults admitted with CS. Patients were classified according to SHARC criteria: acute myocardial infarction (AMI)-CS (n = 303, 22.5%), heart failure (HF)-CS (n = 56, 5.0%), secondary-CS (n = 433, 29.9%), and post-cardiotomy-CS (n = 574, 42.7%). The primary outcome was 30-day all-cause mortality. Multivariable logistic regression models assessed independent predictors of mortality and comparative prognostic performance using Akaike Information Criterion, Bayesian Information Criterion, and discrimination indices.
Results:
Thirty-day mortality varied significantly across SHARC classes: AMI-CS (48.7%), HF-CS (45.6%), secondary-CS (39.0%), and post cardiotomy-CS (17.3%) (p < 0.001). Multivariable analysis identified age, epinephrine use, vasopressin use, arterial lactate, right ventricular dysfunction, and SHARC classification as independent mortality predictors (all P < 0.05). Adding SHARC classification to clinical variables provided greater incremental prognostic value (ΔAIC = -48.3; AUC=0.734; R2 = 0.198) than SCAI classification alone (ΔAIC = -20.0; AUC = 0.723; R2 = 0.172). The combined model integrating SHARC, SCAI, and hemodynamic parameters demonstrated the best performance (AUC = 0.819; R2 = 0.355).
Conclusions:
SHARC etiological classification provides complementary discrimination for 30-day mortality compared with SCAI staging alone, suggesting that shock pathophysiology influences patient outcomes. Integration of both classifications may improve risk stratification and enable more personalized therapeutic approaches in cardiogenic shock management.
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