Epidemiology and Prognostic Significance of Acute Non-Cardiac Organ Dysfunction across Cardiogenic Shock Subtypes: Varshney et al; Non-Cardiac Organ Dysfunction in CS.

Background: The epidemiology and prognostic significance of acute non-cardiac organ dysfunction across cardiogenic shock (CS) subtypes are not well-defined.

Methods: CS admissions from 2017-2022 in the Critical Care Cardiology Trials Network Registry were classified as acute myocardial infarction-related CS (AMI-CS), acute-on-chronic heart failure-related CS (AoC HF-CS), or de novo HF-CS, and categorized as having at least moderate respiratory, kidney, liver, and/or neurologic dysfunction using established criteria. Burden of organ dysfunction was defined as no organ dysfunction (NOD), single organ dysfunction (SOD), or multi (≥2) organ dysfunction (MOD). Multivariable models were used to evaluate associations of burden and type of non-cardiac organ dysfunction with in-hospital death.

Results: Among 3,904 CS admissions, 29.4% had AMI-CS, 50.9% had AoC HF-CS, and 19.7% had de novo HF-CS. AMI-CS and de novo HF-CS had greater prevalence of MOD (35.0% and 33.9%, respectively) compared with AoC HF-CS (23.1%; p<0.01). In-hospital mortality was higher with greater burden of organ dysfunction in the overall CS cohort (SOD vs. NOD: adjusted odds ratio [aOR] for in-hospital death 2.5, 95% confidence interval [CI] 2.0-3.2; MOD vs. NOD: aOR 6.5, 95% CI 5.1-8.2) and across each CS subtype. Kidney dysfunction was the most prognostically important form of organ dysfunction in the overall cohort (aOR 4.1, 95% CI 3.4-5.0) and for each CS subtype.

Conclusion: Admissions for AoC HF-CS had a lower burden of acute non-cardiac organ dysfunction compared with admissions for de novo HF-CS and AMI-CS. However, acute non-cardiac organ dysfunction burden was similarly adversely prognostic across all CS subtypes.