Cardiogenic shock and infection: A lethal combination

被引:0
|
作者
Cherbi, Miloud [1 ,2 ]
Merdji, Hamid [3 ]
Labbe, Vincent [4 ]
Bonnefoy, Eric [5 ]
Lamblin, Nicolas [6 ]
Roubille, Francois [7 ]
Levy, Bruno [8 ]
Lim, Pascal [9 ,10 ]
Khachab, Hadi [11 ]
Schurtz, Guillaume [7 ]
Harbaoui, Brahim [12 ,13 ,14 ]
Vanzetto, Gerald [15 ]
Combaret, Nicolas [16 ]
Marchandot, Benjamin [17 ]
Lattuca, Benoit [18 ]
Biendel-Picquet, Caroline [1 ,2 ]
Leurent, Guillaume [19 ]
Gerbaud, Edouard [20 ,21 ]
Puymirat, Etienne [22 ,23 ]
Bonello, Laurent [24 ,25 ,26 ]
Delmas, Clement [1 ,2 ]
机构
[1] Rangueil Univ Hosp, Intens Cardiac Care Unit, 1 Ave Jean Poulhes, F-31059 Toulouse, France
[2] Inst Metab & Cardiovasc Dis I2MC, Inserm, UMR 1048, F-31432 Toulouse, France
[3] CHU Strasbourg, Med Intens Care Unit, F-67000 Strasbourg, France
[4] Hop Tenon, Cardiol Dept, AP HP, F-75020 Paris, France
[5] Lyon Univ Hosp, Intens Cardiac Care Unit, F-69500 Bron, France
[6] Univ Lille, Urgences & Soins Intens Cardiol, CHU Lille, Inserm,U1167, F-59000 Lille, France
[7] Univ Montpellier, Cardiol Dept, CHU Montpellier, PhyMedExp,CNRS, F-34090 Montpellier, France
[8] CHRU Nancy, Reanimat Medicale Brabois, F-54511 Vand?uvre Les Nancy, France
[9] Univ Paris Est Creteil, Inserm, IMRB, F-94010 Creteil, France
[10] Hop Univ Henri Mondor, Serv Cardiol, AP HP, F-94010 Creteil, France
[11] CH Aix en Provence, Dept Cardiol, Intens Cardiac Care Unit, F-13616 Aix En Provence, France
[12] Hosp Civils Lyon, Hop Croix Rousse, Cardiol Dept, F-69004 Lyon, France
[13] Hosp Civils Lyon, Hop Lyon Sud, F-69004 Lyon, France
[14] Univ Lyon, CREATIS, Inserm, UMR 5220,U1044,INSA 15 Lyon, F-69621 Villeurbanne, France
[15] Hop Grenoble, Dept Cardiol, F-38700 La Tronche, France
[16] Univ Clermont Auvergne, Dept Cardiol, CHU Clermont Ferrand, CNRS, F-63000 Clermont Ferrand, France
[17] Univ Strasbourg, Nouvel Hop Civil, CHU, Pole Act Med Chirurgicale Cardiovasc, F-67091 Strasbourg, France
[18] Montpellier Univ, Nimes Univ Hosp, Dept Cardiol, F-30900 Nimes, France
[19] Univ Rennes 1, Dept Cardiol, CHU Rennes, Inserm,LTSI,UMR 1099, F-35000 Rennes, France
[20] Hop Cardiol Haut Leveque, Intens Cardiac Care Unit & Intervent Cardiol, F-33604 Pessac, France
[21] Bordeaux Univ, Hop Xavier Arnozan, Bordeaux Cardiothorac Res Ctr, U1045, F-33600 Pessac, France
[22] Hop Europeen Georges Pompidou, Dept Cardiol, AP HP, F-75015 Paris, France
[23] Univ Paris, F-75006 Paris, France
[24] Aix Marseille Univ, F-13385 Marseille, France
[25] Hop Nord Marseille, Dept Cardiol, Intens Care Unit, AP HM, F-13385 Marseille, France
[26] Mediterranean Assoc Res & Studies Cardiol MARS Car, F-13015 Marseille, France
关键词
Cardiogenic shock; Sepsis; Epidemiology; Prognosis; Mortality; ACUTE ORGAN DYSFUNCTION; SEPTIC SHOCK; SEPSIS; CLASSIFICATION; COMPLICATIONS;
D O I
10.1016/j.acvd.2024.04.005
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock. Methods: FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1 year. Results: Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs. 81.2%; P = 0.16), norepinephrine (72.5% vs. 50.8%; P < 0.01), renal replacement therapy (29.7% vs. 14%; P < 0.01), non-invasive ventilation (36.3% vs. 24.4%; P = 0.09) and invasive ventilation (52.7% vs. 35.9%; P = 0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs. 24.0%; adjusted hazard ratio: 1.94, 95% confidence interval: 1.36-2.76; P < 0.01) and 1-year (62.0% vs. 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32-2.33; P < 0.01) all-cause death rates. No significant difference was found at 1 year for heart transplantation or ventricular assistance device (8.7% vs. 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32-1.64; P = 0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a preexisting cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death. Conclusions: The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of preexisting cardiomyopathy.
引用
收藏
页码:470 / 479
页数:10
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