Acute cardiac care & resuscitation
Early Serial Assessment of Aggregate Vasoactive Support and Mortality in Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network Registry
Authors' conclusion
Early changes in the magnitude of vasoactive support in CS are associated with a gradient of risk for mortality.
Study context
- Population
- Patients admitted with cardiogenic shock to cardiac ICUs, Critical Care Cardiology Trials Network registry, 2018–2023
- Participants
- 3,665 patients
- Exposure
- Change in vasoactive-inotropic score (VIS) from 4 to 24 hours
- Outcome
- Cardiac ICU mortality
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Cardiac ICU mortality by change in VIS from 4 to 24 hours
- Graded association of change in VIS with mortality, stratified by 4-hour VIS: 2- to >4-fold difference in mortality, ≥10-point increase vs ≥10-point decrease
- P for trend < 0.0001
- Discrimination of cardiac ICU mortality by change in VIS alone (C-statistic)
- 0.72 (95% CI 0.70-0.75)
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Mortality per 10-point higher 24-hour VIS, by mechanical circulatory support · per 10-point higher 24-hour VIS | 1.36 (1.23–1.49) | |
| Mortality per 10-point higher 24-hour VIS, by mechanical circulatory support · 24 hoursWithout mechanical circulatory support · per 10-point higher 24-hour VIS | 1.84 (1.69–2.01) | |
| 0.512Odds ratio (log scale) |
- Mortality per 10-point higher 24-hour VIS, by mechanical circulatory support: Pinteraction <0.0001
Cardiac ICU mortality by VIS at 4 and 24 hours
- 4-hour VIS <10 to ≥40: mortality
- 13%-45%
- 24-hour VIS <10 to ≥40: mortality
- 11%-73%
- Trend for each time point
- P for trend < 0.0001
Improvement in discrimination by adding change in VIS (C-statistic)
- 24-hour SOFA score
- 0.72 (95% CI 0.69-0.74) to 0.76 (95% CI 0.74-0.78)
- Clinician-assessed SCAI shock stage
- 0.72 (95% CI 0.70-0.74) to 0.77 (95% CI 0.75-0.79)
Original publication
Early Serial Assessment of Aggregate Vasoactive Support and Mortality in Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network Registry. Circ Heart Fail. Published 8 April 2024. doi:10.
Summarised from the published abstract; every number is checked against it