Tipo di tesi
Tesi di specializzazione (4 anni)
Titolo
Predicting survival or successful bridge to heart replacement therapy in patients with acute decompensated heart failure complicated by cardiogenic shock
Dipartimento
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
MALATTIE DELL'APPARATO CARDIOVASCOLARE
Parole chiave
- ADHF
- CS
- ICU
- risk-score
- short-term mortality
Data inizio appello
04/11/2019
Consultabilità
Non consultabile
Data di rilascio
04/11/2089
Riassunto (Italiano)
Background: Data from US and European registries have recently shown a changing paradigm in the epidemiology of cardiogenic shock (CS), which is shifting from a mainly post-acute myocardial infarction (AMI) syndrome to a deterioration of acute decompensated heart failure (ADHF). Since the pathophysiology of these two conditions is different, patient management becomes a real challenge for the intensivists. Notably, no dedicated score for the prediction of short-term mortality risk score has been tested in the CS-ADHF population.
Purpose: 1) To evaluate the effectiveness of existing scores (SOFA: Sequential Organ Failure Assessment; SAPS II: Simplified Acute Physiology Score; inotropic and CardShock score); and 2) to derive a new score for the prediction 28-day survival in CS-ADHF patients.
Methods: We retrospectively collected data on 88 consecutive patients who presented with CS-ADHF between 2009 and 2019. Multivariate logistic analysis was used to assess the association between selected independent variables and 28-day all-cause survival. c-statistic was used to evaluate the discrimination ability of the model.
Results: 28-day survival was 66%. Among survived patients, 46 were treated with heart replacement therapy: 30 orthotopic heart transplantation (52%) and 16 durable left ventricle assist device (LVAD) implantation (27%). A new score (ALC – Shock) was derived based on age, serum lactates and serum creatinine (at ICU admission). ALC–Shock showed the best discrimination ability (AUC 0.8; 95% CI 0-7-0.9) compared to SOFA, SAPSII, Cardshock score and inotropic score (p = 0.009) for 28-day survival. Notably, other variables deemed clinically relevant, including cardiac power output and pulmonary artery pulsatility index, did not show a significant association with 28-day survival.
Conclusions: The ALC – Shock score, which includes age, serum creatinine and lactates at ICU admission, offers a new powerful stratification tool for prediction of short-term survival in CS-ADHF patients.
