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Epidemiology and Prognostic Significance of Acute Non-Cardiac Organ Dysfunction across Cardiogenic Shock Subtypes: Varshney et al; Non-Cardiac Organ Dysfunction in CS.
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Epidemiology and Prognostic Significance of Acute Non-Cardiac Organ Dysfunction across Cardiogenic Shock Subtypes: Varshney et al; Non-Cardiac Organ Dysfunction in CS. Journal of cardiac failure Varshney, A. S., Palazzolo, M. G., Barnett, C. F., Bohula, E. A., Burke, J. A., Chaudhry, S. P., Chonde, M. D., Ghafghazi, S., Gerber, D. A., Kenigsberg, B., Kontos, M. C., Kwon, Y., Lawler, P. R., Loriaux, D. B., Menon, V., Miller, E., O'Brien, C. G., Papolos, A. I., Patel, S. M., Potter, B. J., Prasad, R., Shah, K. S., Sinha, S. S., Solomon, M. A., Thompson, A., Teuteberg, J. J., van Diepen, S., Morrow, D. A., Berg, D. D. 2025Abstract
The epidemiology and prognostic significance of acute non-cardiac organ dysfunction across cardiogenic shock (CS) subtypes are not well-defined.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.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.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.
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