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Tesi etd-10142019-235016


Thesis type
Tesi di specializzazione (4 anni)
Author
VILLANOVA, LUCA
URN
etd-10142019-235016
Title
Predicting survival or successful bridge to heart replacement therapy in patients with acute decompensated heart failure complicated by cardiogenic shock
Struttura
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
MALATTIE DELL'APPARATO CARDIOVASCOLARE
Supervisors
relatore Prof. Pedrinelli, Roberto
correlatore Dott. Nuccia Morici
Parole chiave
  • ADHF
  • CS
  • risk-score
  • short-term mortality
  • ICU
Data inizio appello
04/11/2019;
Consultabilità
Secretata d'ufficio
Data di rilascio
04/11/2089
Riassunto analitico
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.
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