Abstract Background Acute decompensated heart failure (ADHF) accounts for approximately 50% of hospital admissions for cardiogenic shock (CS) 1). Although inotropes, vasopressors, and mechanical circulatory support (MCS) improve hemodynamics, in-hospital mortality for CS remains high 2). The predictors of in-hospital mortality in ADHF-related CS requiring catecholamines remain unclear despite their widespread use. Purpose This study aims to identify predictors of in-hospital mortality, including vital signs after catecholamine administration, in patients with ADHF-related CS. Methods We enrolled ADHF patients requiring catecholamine support at our institute from January 2015 to December 2024. Patients were included based on the SCAI shock stage classification if they met any of the following criteria: (1) acute change in mental status or cold sweat; (2) systolic blood pressure ≤90 mmHg; (3) urine output ≤30 mL/h; (4) an increase in creatinine of ≥0.3 mg/dL from baseline; or (5) alanine aminotransferase ≥200 U/L 3). Patients on dialysis, those who experienced cardiac arrest, and individuals with MCS inserted before catecholamine treatment were excluded. Due to the limited number of events, only significant variables from the univariate analysis were included in the multivariate analysis, using the backward elimination method. Receiver operating characteristic curves were used to determine the cut-off values for age and urine volume. Results A total of 196 patients with ADHF-related CS were included, and 38 (19.4%) died during hospitalization. Table 1 presents the results of univariate and multivariate analyses, identifying older age and lower urine output 24 hours after catecholamine administration as poor prognostic factors. Furthermore, Figure 1 shows that reduced urine output per body weight per hour was associated with in-hospital mortality based on Kaplan-Meier analysis. Conclusion Urine output 24 hours after catecholamine administration is a novel predictor of in-hospital mortality in patients with ADHF-related CS. In these patients, additional treatment strategies, including MCS insertion, should be considered to improve outcomes.
Kawanami et al. (Sat,) studied this question.