Key result
ALC-shock score outperforms Cardshock score for predicting 28-day mortality with AUC ~0.82 vs 0.67.
Why the study?
Acute decompensated heart failure complicated by cardiogenic shock requires specific patient stratification and management, but simple predictive tools for survival are lacking.
Cohort (n=180)
Yes
Effect estimate: AUC 0.82 (95% CI 0.73-0.91)
Absolute Event Rate: 0.82% vs 0.67%
p-value: p=0.009
May refine mortality risk prediction in cardiogenic shock; leaves open prospective validation before clinical adoption.
BACKGROUND: Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS. METHODS AND RESULTS: Using logistic regression, univariable testing was performed to identify the variables potentially associated with 28-day mortality. We propose a new logistic model (ALC-Shock score) based on three easy parameters (age, serum creatinine and serum lactate at the ICU admission) as a powerful predictor of survival or successful bridge to heart replacement therapy at 28-day follow-up in this specific population. A multivariable analysis (logistic model) was performed to evaluate the association between selected variables and outcome (overall death at 28-day follow up). The score was then validated in a different cohort of 93 ADHF-CS patients and compared to a previous developed score (the Cardshock score).Overall, 28-day mortality was 34%. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73-0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55-0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66. CONCLUSIONS: A simple score including age, lactates and creatinine on admission could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification.
No takes yet. Share an insight, caveat, or question.
Morici et al. (2021) conducted a cohort in Acute decompensated heart failure complicated by cardiogenic shock (ADHF-CS) (n=180). ALC-Shock score vs. Cardshock score was evaluated on Discrimination for predicting 28-day overall mortality (Area Under the Curve) (AUC 0.82, 95% CI 0.73-0.91, p=0.009). The ALC-shock score showed better discrimination for predicting 28-day overall mortality compared to the Cardshock score (AUC 0.82 vs 0.67, p = 0.009).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: