Distinct clinical phenotypes of cardiogenic shock an their association with in-hospital outcomes

Introduction Cardiogenic shock (CS) remains a heterogeneous syndrome with persistently high mortality despite advances in revascularization and circulatory support. Identifying distinct phenotypes may help tailor therapy and improve outcomes. Objective To identify and characterize CS phenotypes based on age and renal replacement therapy (RRT), and assess their association with etiology, management, and in-hospital mortality. Methods We retrospectively analyzed consecutive patients admitted to a cardiovascular intensive care unit (2011–2024) with CS. Demographics, comorbidities, analytical parameters (creatinine, pH), and therapies (IABP, vasopressin, coronary intervention) were recorded. Patients were classified as phenotype 1 (≤75 years), phenotype 2 (>75 years), and phenotype 3 (RRT required). Those requiring RRT were classified as phenotype 3 regardless of age. Differences were analyzed with one-way ANOVA and chi-square tests (p < 0.05). Results Among 762 patients, 397 (52.1%) were phenotype 1, 300 (39.4%) phenotype 2, and 65 (8.5%) phenotype 3. Mean age differed significantly (62.3 ± 9.3 vs 82.3 ± 4.5 vs 72.1 ± 9.6 years; p < 0.001). Male sex predominated in phenotype 1 (79.3% vs 60.7% vs 70.8%; p < 0.001). Hypertension (58.9%, 80.7%, 81.5%; p < 0.001) and diabetes (37.5%, 41.1%, 58.5%; p = 0.006) were more frequent in phenotypes 2–3. Atrial fibrillation was more common in phenotype 2 (13.9% vs 7.4% vs 12.5%; p = 0.025). Etiology differed (p = 0.009), with STEMI/NSTEMI predominating in phenotypes 1 and 3 and a more balanced distribution in 2. LVEF varied (31 ± 16%, 29 ± 15%, 35 ± 15%; p = 0.003), lowest in phenotype 2. Phenotype 3 showed severe renal dysfunction (creatinine 4.8 ± 10.6 mg/dL vs 1.4 ± 1.0 and 1.5 ± 0.8; p < 0.001) and lower CKD-EPI clearance (32.3 ± 24.4 vs 62.8 ± 24.7 vs 46.6 ± 20.0 mL/min; p < 0.001). Hemoglobin was lower in phenotypes 2–3 (12.6 ± 2.4 and 12.0 ± 2.4 vs 13.8 ± 2.4 g/dL; p < 0.001). Vasopressin use was higher in phenotype 3 (4.8% vs 3.7% vs 23.1%; p < 0.001), as were endotracheal intubation (58.5%; p < 0.001) and IABP use (24.6% vs 16.4% vs 8.4%; p < 0.001). Mortality rose progressively across phenotypes: 21.0%, 28.6%, 58.7% (p < 0.001). Conclusions Stratification by age and RRT defines three distinct CS phenotypes. RRT identifies patients with severe renal dysfunction, greater support needs, and markedly higher mortality. Age adds prognostic weight but does not modify RRT impact. These findings underscore RRT as a marker of severity and potential therapeutic target in cardiogenic shock.Table 1:baseline characteristics Figure 1:hemodynamic and suppport