Epidemiology and Prognostic Significance of Acute Noncardiac Organ Dysfunction Across Cardiogenic Shock Subtypes

Abstract

Background

The epidemiology and prognostic significance of acute noncardiac organ dysfunction across cardiogenic shock (CS) subtypes are not well-defined.

Methods

CS admissions from 2017 to 2022 in the Critical Care Cardiology Trials Network Registry were classified as acute myocardial infarction-related CS (AMI-CS), acute-on-chronic heart failure-related CS (AoC HF-CS), or de novo HF-CS, and categorized as having at least moderate respiratory, kidney, liver, and/or neurological dysfunction using established criteria. Burden of organ dysfunction was defined as no noncardiac organ dysfunction (NOD), single organ dysfunction, or multiorgan dysfunction ($\ge$2) (MOD). Multivariable models were used to evaluate associations of burden and type of noncardiac organ dysfunction with in-hospital death.

Results

Among 3904 CS admissions, 29.4% had AMI-CS, 50.9% had AoC HF-CS, and 19.7% had de novo HF-CS. AMI-CS and de novo HF-CS had greater prevalence of MOD (35.0% and 33.9%, respectively) compared with AoC HF-CS (23.1%; P < .01). In-hospital mortality was higher with a greater burden of organ dysfunction in the overall CS cohort (single organ dysfunction vs NOD, adjusted odds ratio [aOR] for in-hospital death 2.5, 95% confidence interval [CI] 2.0–3.2; MOD vs NOD: aOR 6.5, 95% CI 5.1–8.2) and across each CS subtype. Kidney dysfunction was the most prognostically important form of organ dysfunction in the overall cohort (aOR 4.1, 95% CI 3.4–5.0) and for each CS subtype.

Conclusions

Admissions for AoC HF-CS had a lower burden of acute noncardiac organ dysfunction compared with admissions for de novo HF-CS and AMI-CS. However, acute noncardiac organ dysfunction burden was similarly adversely prognostic across all CS subtypes.