Risk Stratification in Predicting Cardiogenic Shock 30-Day Mortality admitted to ICU: beyond the Prognostic...

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.