Miloud Cherbi , Hamid Merdji , Vincent Labbé , Eric Bonnefoy , Nicolas Lamblin , François Roubille , Bruno Levy , Pascal Lim , Hadi Khachab , Guillaume Schurtz , Brahim Harbaoui , Gerald Vanzetto , Nicolas Combaret , Benjamin Marchandot , Benoit Lattuca , Caroline Biendel-Picquet , Guillaume Leurent , Edouard Gerbaud , Etienne Puymirat , Laurent Bonello , Clément Delmas
{"title":"心源性休克和感染：致命的组合","authors":"Miloud Cherbi , Hamid Merdji , Vincent Labbé , Eric Bonnefoy , Nicolas Lamblin , François Roubille , Bruno Levy , Pascal Lim , Hadi Khachab , Guillaume Schurtz , Brahim Harbaoui , Gerald Vanzetto , Nicolas Combaret , Benjamin Marchandot , Benoit Lattuca , Caroline Biendel-Picquet , Guillaume Leurent , Edouard Gerbaud , Etienne Puymirat , Laurent Bonello , Clément Delmas","doi":"10.1016/j.acvd.2024.04.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock.</div></div><div><h3>Methods</h3><div>FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1<!--> <!-->year.</div></div><div><h3>Results</h3><div>Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs. 81.2%; <em>P</em> <!-->=<!--> <!-->0.16), norepinephrine (72.5% vs. 50.8%; <em>P</em> <!--><<!--> <!-->0.01), renal replacement therapy (29.7% vs. 14%; <em>P</em> <!--><<!--> <!-->0.01), non-invasive ventilation (36.3% vs. 24.4%; <em>P</em> <!-->=<!--> <!-->0.09) and invasive ventilation (52.7% vs. 35.9%; <em>P</em> <!-->=<!--> <!-->0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs. 24.0%; adjusted hazard ratio: 1.94, 95% confidence interval: 1.36–2.76; <em>P</em> <!--><<!--> <!-->0.01) and 1-year (62.0% vs. 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32–2.33; <em>P</em> <!--><<!--> <!-->0.01) all-cause death rates. No significant difference was found at 1<!--> <!-->year for heart transplantation or ventricular assistance device (8.7% vs. 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32–1.64; <em>P</em> <!-->=<!--> <!-->0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a preexisting cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death.</div></div><div><h3>Conclusions</h3><div>The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of preexisting cardiomyopathy.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cardiogenic shock and infection: A lethal combination\",\"authors\":\"Miloud Cherbi , Hamid Merdji , Vincent Labbé , Eric Bonnefoy , Nicolas Lamblin , François Roubille , Bruno Levy , Pascal Lim , Hadi Khachab , Guillaume Schurtz , Brahim Harbaoui , Gerald Vanzetto , Nicolas Combaret , Benjamin Marchandot , Benoit Lattuca , Caroline Biendel-Picquet , Guillaume Leurent , Edouard Gerbaud , Etienne Puymirat , Laurent Bonello , Clément Delmas\",\"doi\":\"10.1016/j.acvd.2024.04.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock.</div></div><div><h3>Methods</h3><div>FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1<!--> <!-->year.</div></div><div><h3>Results</h3><div>Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs. 81.2%; <em>P</em> <!-->=<!--> <!-->0.16), norepinephrine (72.5% vs. 50.8%; <em>P</em> <!--><<!--> <!-->0.01), renal replacement therapy (29.7% vs. 14%; <em>P</em> <!--><<!--> <!-->0.01), non-invasive ventilation (36.3% vs. 24.4%; <em>P</em> <!-->=<!--> <!-->0.09) and invasive ventilation (52.7% vs. 35.9%; <em>P</em> <!-->=<!--> <!-->0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs. 24.0%; adjusted hazard ratio: 1.94, 95% confidence interval: 1.36–2.76; <em>P</em> <!--><<!--> <!-->0.01) and 1-year (62.0% vs. 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32–2.33; <em>P</em> <!--><<!--> <!-->0.01) all-cause death rates. No significant difference was found at 1<!--> <!-->year for heart transplantation or ventricular assistance device (8.7% vs. 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32–1.64; <em>P</em> <!-->=<!--> <!-->0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a preexisting cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death.</div></div><div><h3>Conclusions</h3><div>The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of preexisting cardiomyopathy.</div></div>\",\"PeriodicalId\":55472,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1875213624002183\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1875213624002183","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Cardiogenic shock and infection: A lethal combination
Background
Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock.
Methods
FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1 year.
Results
Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs. 81.2%; P = 0.16), norepinephrine (72.5% vs. 50.8%; P < 0.01), renal replacement therapy (29.7% vs. 14%; P < 0.01), non-invasive ventilation (36.3% vs. 24.4%; P = 0.09) and invasive ventilation (52.7% vs. 35.9%; P = 0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs. 24.0%; adjusted hazard ratio: 1.94, 95% confidence interval: 1.36–2.76; P < 0.01) and 1-year (62.0% vs. 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32–2.33; P < 0.01) all-cause death rates. No significant difference was found at 1 year for heart transplantation or ventricular assistance device (8.7% vs. 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32–1.64; P = 0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a preexisting cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death.
Conclusions
The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of preexisting cardiomyopathy.
期刊介绍：
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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