Clinical Picture and Risk Prediction of Short-Term Mortality of Mechanically Ventilated Patients Presented with Cardiogenic Shock in Intensive Cardiovascular Care Unit of Saiful Anwar General Hospital
Author : H. A. Liemena*, F. W. Nugroho, D. H. Karimullah, Setyasih Anjarwani
Upload Date : 19-04-2018
Aims: The aim of this study was to investigate the clinical picture and risk predictors of short-term mortality of mechanically ventilated patients with cardiogenic shock in Intensive Cardiovascular Care Unit (CVCU) of Saiful Anwar General Hospital.
Methods: This research was a single-centre, retrospective, observational study conducted between January to June 2017. Patients on invasive mechanical ventilation with cardiogenic shock were enrolled (n=41, mean age 60, 63% men). Data on clinical presentation, demographic characteristics, prior history and biochemical variables were compared between different aetiologies of shock (acute coronary syndrome/ACS vs. non-ACS). Between-group comparisons were statistically analyzed using Student’s t-test. Differences in mortality were assessed by logistic regression (presented as ORs with 95% CI) or by drawing Kaplan-Meier survival curves which then were compared with the log-rank test. Significance was defined as p <0.05.
Results: From 72 mechanically ventilated subjects, there were 41 diagnosed with cardiogenic shock. The aetiologies of shock account similar in ACS and non-ACS (51%, 49%; respectively). Main non-ACS aetiologies were severe chronic heart failure, heart blocks, and valvular causes. History of diabetes, chronic kidney disease, cardiac arrest presentation, low LVEF, confusion, albumin level, CardShock score, and in-hospital mortality were significantly different between two groups (p <0.05). In-hospital mortality rate was 68% (n=28). ACS etiology, arterial lactate, arterial pH, APACHE II score, CardShock score, length of ventilator use, and low LVEF were independently associated with increased mortality (log rank p-value=0.03).
Conclusion: Both ACS and non-ACS account similar for half of shock cases. Seven variables are independently associated with in-hospital mortality. A simple local risk prediction score may develop, to easily help risk stratification of short-term mortality and facilitate early decision making in managing mechanically ventilated patients with cardiogenic shock in CVCU of Saiful Anwar General Hospital.
KEYWORDS : cardiogenic shock, mechanical ventilation, in-hospital mortality, risk predictor, acute coronary syndrome
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