TY - JOUR
T1 - Cardiogenic shock in intensive care units
T2 - evolution of prevalence, patient profile, management and outcomes, 1997–2012
AU - on behalf of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa Group [Intensive Care Database User Group])
AU - Puymirat, Etienne
AU - Fagon, Jean Yves
AU - Aegerter, Philippe
AU - Diehl, Jean Luc
AU - Monnier, Alexandra
AU - Hauw-Berlemont, Caroline
AU - Boissier, Florence
AU - Chatellier, Gilles
AU - Guidet, Bertrand
AU - Danchin, Nicolas
AU - Aissaoui, Nadia
N1 - Publisher Copyright:
© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Aim: To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years. Methods and results: From the 1997–2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes [Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality] and predictors of in-ICU mortality. Of the 316 905 ICU admissions, 19 416 (6.1%) exhibited CS, with incidence increasing from 4.1% to 7.7% (P < 0.001). Over time, the age of admitted patients decreased by 2.7 years [95% confidence interval (CI), −2.0 to −3.4] and SAPS-II increased by 5.8% (95% CI 4.8–6.8) from 58.7 ± 25.3 to 64.5 ± 23.3 (P < 0.001). Crude in-ICU mortality declined from 50% to 45% (−5.6%; 95% CI −7.7 to −3.5) as SAPS-II Standardized ICU mortality rates decreased from 56.5% to 44.2% (P < 0.001). A more recent time-period was an independent correlate of decreased mortality in multivariate analyses. The decrease in mortality rate was more marked in patients with decompensated heart failure, cardiac arrest, or acute myocardial infarction. Conclusions: Patients with CS represent a greater proportion of patients admitted to ICUs over the past 15 years, having become younger but more critically ill. Although their mortality has decreased, suggesting improved overall patient management, it remains particularly high, warranting further research specifically focused on this population.
AB - Aim: To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years. Methods and results: From the 1997–2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes [Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality] and predictors of in-ICU mortality. Of the 316 905 ICU admissions, 19 416 (6.1%) exhibited CS, with incidence increasing from 4.1% to 7.7% (P < 0.001). Over time, the age of admitted patients decreased by 2.7 years [95% confidence interval (CI), −2.0 to −3.4] and SAPS-II increased by 5.8% (95% CI 4.8–6.8) from 58.7 ± 25.3 to 64.5 ± 23.3 (P < 0.001). Crude in-ICU mortality declined from 50% to 45% (−5.6%; 95% CI −7.7 to −3.5) as SAPS-II Standardized ICU mortality rates decreased from 56.5% to 44.2% (P < 0.001). A more recent time-period was an independent correlate of decreased mortality in multivariate analyses. The decrease in mortality rate was more marked in patients with decompensated heart failure, cardiac arrest, or acute myocardial infarction. Conclusions: Patients with CS represent a greater proportion of patients admitted to ICUs over the past 15 years, having become younger but more critically ill. Although their mortality has decreased, suggesting improved overall patient management, it remains particularly high, warranting further research specifically focused on this population.
UR - http://www.scopus.com/inward/record.url?scp=84995616637&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84995616637&partnerID=8YFLogxK
U2 - 10.1002/ejhf.646
DO - 10.1002/ejhf.646
M3 - Article
C2 - 27709722
AN - SCOPUS:84995616637
SN - 1388-9842
VL - 19
SP - 192
EP - 200
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 2
ER -