Modified reverse shock index predicts early outcomes of heart failure with reduced ejection fraction

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Aims Increased blood pressure (BP) and decreased heart rate (HR) are signs of stabilization in patients admitted for acute HF. Changes in BP and HR during admission and their correlation with outcomes were assessed in hospitalized patients with heart failure (HF) with reduced ejection fraction (HFrEF). Methods A novel modified reverse shock index (mRSI), defined as the ratio between changes in systolic BP and HR during admission, was devised, and its prognostic value in the early outcomes of acute HF was assessed using the Korean Acute HF registry. Results Among 2697 patients with HFrEF (mean age 65.8 ± 14.9 years, 60.6% males), patients with mRSI ≥1.25 at discharge were significantly younger and were more likely to have de novo HF. An mRSI ≥1.25 was associated with a significantly lower incidence of 60‐day and 180‐day all‐cause mortality [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.31–0.77; HR 0.62, 95% CI 0.45–0.85, respectively], compared with 1 ≤ mRSI < 1.25 (all P < 0.001). Conversely, an mRSI <0.75 was associated with a significantly higher incidence of 60‐day and 180‐day all‐cause mortality (adjusted HR 2.08, 95% CI 1.19–3.62; HR 2.24, 95% CI 1.53–3.27; all P < 0.001). The benefit associated with mRSI ≥1.25 was consistent in sub‐group analyses. The correlation of mRSI and outcomes were also consistent regardless of admission SBP, presence of atrial fibrillation, or use of beta blockers at discharge. Conclusions In patients hospitalized for HFrEF, the mRSI was a significant predictor of early outcomes. The mRSI could be used as a tool to assess patient status and guide physicians in treating patients with HFrEF.

Modified reverse shock index predicts early outcomes of heart failure with reduced ejection fraction

Lee

et al. 2022

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Decoding cardiogenic shock: assessing shock index and its variants as prognostic indicators for in‐hospital mortality

Colarusso,

Brahmbhatt,

Scolari

et al. 2024

BackgroundCardiogenic shock (CS) is associated with high in‐hospital mortality. Objective assessment of its severity and prognosis is paramount for timely therapeutic interventions. This study aimed to evaluate the efficacy of the shock index (SI) and its variants as prognostic indicators for in‐hospital mortality.MethodsA retrospective study involving 1282 CS patients were evaluated. Baseline patient characteristics, clinical trajectory, hospital outcomes, and shock indices were collected and analysed. Receiver operating characteristic (ROC) curves were employed to determine the predictive accuracy of shock indices in predicting in‐hospital mortality.ResultsOf those evaluated, 866 (67.6%) survived until discharge. Non‐survivors were older (66.0 ± 13.7 vs. 57.4 ± 16.2, P < 0.001), had a higher incidence of cardiac risk factors, and were more likely to present with acute coronary syndrome (33.4% vs. 16.1%, P < 0.001) and out‐of‐hospital cardiac arrest (11.3% vs. 5.3%, P < 0.001). All mean shock indices were significantly higher in non‐survivors compared with survivors. ROC curves demonstrated that adjusted shock index (ASI), age‐modified shock index (AMSI), and shock index‐C (SIC) had the highest predictive accuracy for in‐hospital mortality, with AUC values of 0.654, 0.667, and 0.659, respectively. Subgroup analysis revealed that SIC had good predictive ability in patients with STEMI (AUC: 0.714) and ACS (AUC: 0.696) while AMSI and ASI were notably predictive in the OHCA group (AUC: 0.707 and 0.701, respectively).ConclusionsShock index and its variants, especially ASI, AMSI, and SIC, may be helpful in predicting in‐hospital mortality in CS patients. Their application could guide clinicians in upfront risk stratification. SIC, ASI, and AMSI show potential in predicting in‐hospital mortality in specific CS subsets (STEMI and OHCA). This is the first study to evaluate SI and its variants in CS patients.

Value of APACHE II, SOFA and CardShock scoring as predictive tools for cardiogenic shock: A single‐centre pilot study

Chlabicz,

Łaguna,

Kazimierczyk

et al. 2024

AimsThe aim of this study was to determine the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and CardShock scoring systems in predicting the risk of in‐hospital, 30 day and 3 year mortality in patients with cardiogenic shock (CS).MethodsThis was a single‐centre observational study conducted between May 2016 and December 2017. Data from consecutive patients with CS admitted to the intensive cardiac care unit (ICCU) were included in the analysis.ResultsThe study group comprised 63 patients with CS {median age 71.0 [interquartile range (IQR), 59–82]; 42 men}: 32 patients with ischaemic and 31 with non‐ischaemic aetiology. The median APACHE II, SOFA and CardShock scores were 13 (IQR, 9.9–19.0) points, 8.0 (IQR, 6.0–10.0) points and 3.0 (IQR, 2.0–5.0) points, respectively. The in‐hospital, 30 day and 3 year mortality rates were 39.7%, 41.3% and 77.8%, respectively. APACHE II and SOFA scores were significantly higher in the group of patients who died at 30 days (P = 0.043 and P = 0.045, respectively). The CardShock score was higher in patients with CS who died in hospital (P = 0.007) and within 30 days (P = 0.004). No score was statistically significant for 3 year mortality. Area under the curve (AUC) analysis showed that the CardShock score had the highest value in predicting in‐hospital and 30 day mortality relative to APACHE II and SOFA, with a cut‐off score of 5 points [AUC: 0.70; 95% confidence interval (CI): 0.59–0.81; P = 0.001] and 4 points (AUC: 0.71; 95% CI: 0.60–0.82; P < 0.001), respectively. The Bayesian Weibull model demonstrated the utility of all scales in estimating short‐term risk in patients with CS, with the impact of APACHE II and SOFA on patient life expectancy decreasing to a non‐significant level at approximately 32 days and CardShock at 33 days. The forest plots derived from the Bayesian logistic regression analysis show significant estimated coefficients with 94% highest density interval (HDI) for in‐hospital and 30 day mortality. The use of invasive or non‐invasive ventilation, a higher heart rate and a less negative fluid balance showed an unfavourable prognosis. Survival was associated with being in the pre‐CS class, with a higher glomerular filtration rate and a higher platelet count.ConclusionsAPACHE II and SOFA could be used for the risk stratification of patients with CS admitted to the ICCU. CardShock proved to be a more appropriate tool for assessing short‐term prognosis in patients with CS of all aetiologies, suggesting that there is potential for its promotion for use in daily clinical practice.