Key result
ALC-shock score improves 28-day mortality discrimination over Cardshock score with ~0.82 AUC.
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
Derivation of ADHF-CS survival tool in small cohort; leaves open prospective validation before clinical use.
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: We analyzed data from a historic cohort of 87 ADHF-CS consecutive patients, eligible to heart replacement therapy (HRT), enrolled between 2015 and 2019. The association between selected independent variables (age, lactates and creatinine, ALC-shock score) and 28-day overall mortality was investigated through a multivariable logistic model. Predictive validity was assessed throughout an internal and external validation and compared to the Cardshock score. A nomogram was developed for predicting 28-day mortality. Overall 28-day mortality was 34%. Among patients who survived, 38 (67%) were treated with HRT: heart transplantation was performed in 68%, the remaining received an LVAD. 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 model including age, lactates and creatinine on admission (ALC-Shock score) could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification. Disclosures: Dr. Garan is supported by National Institutes of Health Grant No. KL2TR001874 and has received honoraria from Abiomed. Dr. Colombo reports institutional grant support from Abbott Vascular. None of the listed entities has had any involvement with the development of the manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.Research ethics: This study was approved by the Local Ethics Committee of Milano Area 3 of the ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano (reference number: 543-23092020).
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Morici et al. (2020) conducted a cohort in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock (n=180). ALC-shock score (age, lactates, and creatinine) vs. Cardshock score was evaluated on Discrimination for 28-day overall mortality (Area Under the Curve) (AUC 0.82, 95% CI 0.73-0.91, p=0.009). The ALC-shock score (incorporating age, serum lactates, and creatinine) demonstrated significantly better discrimination for 28-day mortality than the Cardshock score (AUC 0.82 vs 0.67).
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