Systematic Assessment of Shock Severity in Postoperative Cardiac Surgery Patients.

Humans Retrospective Studies Multiple Organ Failure Cardiac Surgical Procedures / adverse effects Intensive Care Units Shock, Cardiogenic / epidemiology Shock Postoperative Complications / epidemiology Hospital Mortality
cardiac surgery cardiogenic shock cardiovascular critical care mortality

Journal

Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365

Informations de publication

Date de publication:
24 10 2023
Historique:
received: 27 04 2023
revised: 05 07 2023
accepted: 15 08 2023
medline: 23 10 2023
pubmed: 19 10 2023
entrez: 18 10 2023
Statut: ppublish

Résumé

The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification has been shown to provide robust mortality risk stratification in a variety of cardiovascular patients. This study sought to evaluate the SCAI shock classification in postoperative cardiac surgery intensive care unit (CSICU) patients. This study retrospectively analyzed 26,792 postoperative CSICU admissions at a heart center between 2012 and 2022. Patients were classified into SCAI shock stages A to E using electronic health record data. Moreover, the impact of late deterioration (LD) as an additional risk modifier was investigated. The proportions of patients in SCAI shock stages A to E were 24.4%, 18.8%, 8.4%, 35.5%, and 12.9%, and crude hospital mortality rates were 0.4%, 0.6%, 3.3%, 4.9%, and 30.2%, respectively. Similarly, the prevalence of postoperative complications and organ dysfunction increased across SCAI shock stages. After multivariable adjustment, each higher SCAI shock stage was associated with increased hospital mortality (adjusted OR: 1.26-16.59) compared with SCAI shock stage A, as was LD (adjusted OR: 8.2). The SCAI shock classification demonstrated a strong diagnostic performance for hospital mortality (area under the receiver operating characteristic: 0.84), which noticeably increased when LD was incorporated into the model (area under the receiver operating characteristic: 0.90). The SCAI shock classification effectively risk-stratifies postoperative CSICU patients for mortality, postoperative complications, and organ dysfunction. Its application could, therefore, be extended to the field of cardiac surgery as a triage tool in postoperative care and as a selection criterion in research.

Sections du résumé

BACKGROUND
The Society for Cardiovascular Angiography and Interventions (SCAI) shock classification has been shown to provide robust mortality risk stratification in a variety of cardiovascular patients.
OBJECTIVES
This study sought to evaluate the SCAI shock classification in postoperative cardiac surgery intensive care unit (CSICU) patients.
METHODS
This study retrospectively analyzed 26,792 postoperative CSICU admissions at a heart center between 2012 and 2022. Patients were classified into SCAI shock stages A to E using electronic health record data. Moreover, the impact of late deterioration (LD) as an additional risk modifier was investigated.
RESULTS
The proportions of patients in SCAI shock stages A to E were 24.4%, 18.8%, 8.4%, 35.5%, and 12.9%, and crude hospital mortality rates were 0.4%, 0.6%, 3.3%, 4.9%, and 30.2%, respectively. Similarly, the prevalence of postoperative complications and organ dysfunction increased across SCAI shock stages. After multivariable adjustment, each higher SCAI shock stage was associated with increased hospital mortality (adjusted OR: 1.26-16.59) compared with SCAI shock stage A, as was LD (adjusted OR: 8.2). The SCAI shock classification demonstrated a strong diagnostic performance for hospital mortality (area under the receiver operating characteristic: 0.84), which noticeably increased when LD was incorporated into the model (area under the receiver operating characteristic: 0.90).
CONCLUSIONS
The SCAI shock classification effectively risk-stratifies postoperative CSICU patients for mortality, postoperative complications, and organ dysfunction. Its application could, therefore, be extended to the field of cardiac surgery as a triage tool in postoperative care and as a selection criterion in research.

Identifiants

DOI: 10.1016/j.jacc.2023.08.031 PMID: 37852698
pubmed: 37852698
pii: S0735-1097(23)06537-3
doi: 10.1016/j.jacc.2023.08.031
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1691-1706

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Falk has received educational grants (including travel support), fees for lectures and speeches, fees for professional consultation, and research and study funds from Medtronic GmbH, Biotronik SE & Co, Abbott GmbH & Co KG, Boston Scientific, Edwards Lifesciences, Berlin Heart, Novartis Pharma GmbH, JOTEC GmbH, and Zurich Heart. Dr O’Brien has received research funding from the British Heart Foundation and the National Institute for Health Science Research; and has served as a consultant for Teleflex. Dr Schoenrath has received institutional grants from Novartis and Abbott; has received nonfinancial support from Medtronic; and has received institutional fees (speaker honoraria) from Orion Pharma outside of the submitted work. Dr Potapov has received educational grants (including travel support), fees for lectures and speeches, fees for professional consultation, and research and study funds from Medtronic GmbH, Abbott GmbH & Co KG, and Abiomed. Dr Ott has received research and study funds from Novartis Pharma GmbH; and has received consulting fees, fees for lectures, and travel grants from Abiomed Europe GmbH. Dr Balzer has received funding from Medtronic; has received grants from the German Federal Ministry of Education and Research, the German Federal Ministry of Health, the Berlin Institute of Health Hans Böckler Foundation; Einstein Foundation, and the Berlin University Alliance outside the submitted work; has received personal fees from Elsevier Publishing; and has received other from Robert Koch Institute. Dr Meyer has received lecturing fees from Bayer and Medtronic; has received consulting fees from Medtronic and Pfizer; and is founder and managing director of x-cardiac GmbH. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Auteurs

Tobias Roeschl (T)

Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Charité-Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany. Electronic address: tobias.roeschl@dhzc-charite.de.

Nils Hinrichs (N)

Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Charité-Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany.

Matthias Hommel (M)

Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Deutsches Herzzentrum der Charité (DHZC), Department of Cardiac Anesthesiology and Intensive Care Medicine, Berlin, Germany.

Boris Pfahringer (B)

Deutsches Herzzentrum der Charité (DHZC), Centre for Cardiovascular Telemedicine, Berlin, Germany.

Felix Balzer (F)

Charité-Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany.

Volkmar Falk (V)

Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zürich, Switzerland.

Benjamin O'Brien (B)

Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Deutsches Herzzentrum der Charité (DHZC), Department of Cardiac Anesthesiology and Intensive Care Medicine, Berlin, Germany; St Bartholomew's Hospital and Barts Heart Centre, Department of Perioperative Medicine, London, United Kingdom.

Sascha Christoph Ott (SC)

Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Deutsches Herzzentrum der Charité (DHZC), Department of Cardiac Anesthesiology and Intensive Care Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.

Evgenij Potapov (E)

Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.

Felix Schoenrath (F)

Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.

Alexander Meyer (A)

Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Charité-Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.

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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Choc › Systematic Assessment of Shock Severity in...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Systematic Assessment of Shock Severity in...
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