Mortality risk prediction in elderly patients with cardiogenic shock : results from the CardShock study
Hongisto, Mari (Helsinki University Hospital (Finlàndia))
Lassus, Johan (Helsinki University Hospital (Finlàndia))
Tarvasmäki, Tuukka (Helsinki University Hospital (Finlàndia))
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Sans-Rosello, Jordi (Institut d'Investigació Biomèdica Sant Pau)
Tolppanen, Heli (Helsinki University Hospital (Finlàndia))
Kataja, Anu (Helsinki University Hospital (Finlàndia))
Jäntti, Toni (Helsinki University Hospital (Finlàndia))
Sabell, Tuija (Helsinki University Hospital (Finlàndia))
Lindholm, Matias Greve (Zealand University Hospital)
Banaszewski, Marek (National Institute of Cardiology)
Silva Cardoso, Jose (University of Porto, São João University Medical Centre)
Parissis, John (University General Hospital Attikon (Haidari, Grècia))
Di Somma, Salvatore (Sapienza University of Rome)
Carubelli, Valentina (University and Civil Hospital of Brescia)
Jurkko, Raija (Helsinki University Hospital (Finlàndia))
Masip, Josep (Hospital de Sant Joan Despí Moisès Broggi)
Harjola, Veli-Pekka (Helsinki University Hospital (Finlàndia))
Universitat Autònoma de Barcelona

Fecha:	2021
Resumen:	This study aimed to assess the utility of contemporary clinical risk scores and explore the ability of two biomarkers [growth differentiation factor-15 (GDF-15) and soluble ST2 (sST2)] to improve risk prediction in elderly patients with cardiogenic shock. Patients (n = 219) from the multicentre CardShock study were grouped according to age (elderly ≥75 years and younger). Characteristics, management, and outcome between the groups were compared. The ability of the CardShock risk score and the IABP-SHOCK II score to predict in-hospital mortality and the additional value of GDF-15 and sST2 to improve risk prediction in the elderly was evaluated. The elderly constituted 26% of the patients (n = 56), with a higher proportion of women (41% vs. 21%, P < 0. 05) and more co-morbidities compared with the younger. The primary aetiology of shock in the elderly was acute coronary syndrome (84%), with high rates of percutaneous coronary intervention (87%). Compared with the younger, the elderly had higher in-hospital mortality (46% vs. 33%; P = 0. 08), but 1 year post-discharge survival was excellent in both age groups (90% in the elderly vs. 88% in the younger). In the elderly, the risk prediction models demonstrated an area under the curve of 0. 75 for the CardShock risk score and 0. 71 for the IABP-SHOCK II score. Incorporating GDF-15 and sST2 improved discrimination for both risk scores with areas under the curve ranging from 0. 78 to 0. 84. Elderly patients with cardiogenic shock have higher in-hospital mortality compared with the younger, but post-discharge outcomes are similar. Contemporary risk scores proved useful for early mortality risk prediction also in the elderly, and risk stratification could be further improved with biomarkers such as GDF-15 or sST2.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Cardiogenic shock ; Elderly ; Risk prediction ; Biomarker ; GDF-15 ; Sst2
Publicado en:	ESC Heart Failure, Vol. 8 (january 2021) , p. 1398-1407, ISSN 2055-5822

DOI: 10.1002/ehf2.13224
PMID: 33522124

10 p, 563.7 KB

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