The CSP (Cardiogenic Shock Prognosis) Score: A Tool for Risk Stratification of Cardiogenic Shock

Abstract

BackgroundCardiogenic shock (CS) is a critical condition and the leading cause of mortality after acute myocardial infarction (AMI). Scores that predict mortality have been established, but a patient's clinical course is often nonlinear. Thus, factors present during acute care management may be explored. This study intended to develop a risk-predictive model for patients with CS.MethodsIn this observational study, adult patients who received inotropic support at the Emergency Room (ER) from January 2017 to August 2020 and were admitted to the cardiac care unit (CCU) with a diagnosis of CS were enrolled in this study. Patients with out-of-hospital cardiac arrest, inotropic support for bradycardia, and survival <24 h after ER arrival were excluded. A total of 311 patients were enrolled and categorized into derivation (n = 243) and validation (n = 68) cohorts.ResultsA history of coronary artery disease, multiple inotrope use, ejection fraction <40%, lower hemoglobin concentration, longer cardiopulmonary resuscitation duration, albumin infusion, and renal replacement therapy were identified as independent prognostic factors for in-hospital mortality. The cardiogenic shock prognosis (CSP) score was established as a nomogram and three risk groups were identified: low-risk (score 115, 0% of mortality), medium-risk (score 116–209, 8.75% of mortality), and high-risk (score 210, 66.67% of mortality). The area-under-the-curve (AUC) of the CSP score was 0.941, and the discrimination value in the validation cohort was consistent (AUC = 0.813).ConclusionsThe CSP score represents a risk-predictive model for in-hospital mortality in patients with CS in acute care settings. Patients identified as the high-risk category may have a poor prognosis.

WITHDRAWN: The outcomes of initial misclassification of undifferentiated hypotension in the emergency department: A prospective observational study

“…The vasopressors and inotropes included dopamine, norepinephrine, epinephrine, vasopressin, or dobutamine. Patients with high respiratory support were de ned when patients required bilevel positive airway pressure, high-ow oxygen therapy, or endotracheal intubation [21]. The de nition of transfusion was supplementation of blood products, including packed red blood cells, platelets, fresh frozen plasma, or cryoprecipitates.…”

“…The de nition of transfusion was supplementation of blood products, including packed red blood cells, platelets, fresh frozen plasma, or cryoprecipitates. Emergent renal replacement therapy (RRT), such as sustained low-e ciency dialysis, continuous veno-venous hemo ltration, or hemodialysis, was indicated for refractory uid overload with respiratory distress, severe electrolyte imbalance or metabolic acidosis, or overt uremic symptoms [21].…”

A randomized controlled trial of ivabradine in patients with acutemyocardial infarction related cardiogenic shock

“…However, this analysis does not specifically outline the mortality percentage, rather, it only accounts for the patients who died during our trial. It is pertinent to emphasize that CS-AMI is a condition associated with high mortality, so when combining the two patients who passed away and were followed up, along with the four patients who were excluded due to early demise, aligns with mortality rates reported in international studies (22) . Finally, there was no significant difference in mortality observed between the control group and the ivabradine group.…”

Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done

“…A nomogram was established incorporating information from a patient’s medical history, point-of-care and laboratory testing and medical interventions made within 72 h of admission. The score proved to be a reliable predictive tool for in-hospital mortality, but external validation studies are needed [ 72 ].…”