Risk factors and key points in cardiogenic shock

Abstract

Cardiogenic shock is an acute, complex, and multifactorial syndrome caused by severe cardiac dysfunction leading to low cardiac output and tissue hypoperfusion. Identified risk factors (RFs) include: age >75 years, female sex, anterior or extensive acute myocardial infarction (AMI), angina pectoris, peripheral vascular disease, ejection fraction (EF) <30%, mitral regurgitation, and diabetes mellitus. Early diagnosis, advanced hemodynamic monitoring (HM) using PiCCO, identification of mortality-associated RFs, and guidance of fluid and vasopressor therapy are key points in CS management with a major impact on reducing mortality. The aim of our study was to assess mortality-associated RFs in CS and demonstrate the benefit of advanced HM via PiCCO in optimizing treatment and improving outcomes. Out of 86 analyzed parameters, we identified: 6 common RFs for both groups (PiCCO and ECHO): NT-proBNP >4N, acute pulmonary edema, cerebral edema, troponin >2N, total bilirubin >4N, creatinine >2N; 7 PiCCO-specific RFs: VO₂ <100 ml/min, DO₂ <250 ml/min, coma, right ventricular AMI, ERO₂ >60%, PaCO₂ >50 mmHg, hemoglobin <9.0 g/dL; 9 ECHO-specific RFs: hepatomegaly, oliguria <30 ml/h, pyelonephritis, transmural AMI, hepatic failure, stroke, inferior and anteroinferior AMI, lactate >2 mmol/L. All patients with ≥5 RFs (PiCCO group) and ≥7 RFs (ECHO group) died (100%). Male patients had a higher mortality rate (35.8% vs. 26.4%). PiCCO monitoring enabled individualized guidance of fluid and vasopressor therapy, early detection of cardiogenic pulmonary edema, and differentiation from non-cardiogenic forms. Mortality was significantly lower in the PiCCO group compared to the ECHO group (36.5% vs. 62.3%, p=0.0112).