Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study

KATAJA, Anu, Tuukka TARVASMAKI, Johan LASSUS, Lars KOBER, Alessandro SIONIS, Jindřich ŠPINAR, John PARISSIS, Valentina CARUBELLI, Jose CARDOSO, Marek BANASZEWSKI, Rossella MARINO, Markku S NIEMINEN, Alexandre MEBAZAA and Veli-Pekka HARJOLA. Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. LONDON: SAGE PUBLICATIONS LTD, 2018, vol. 7, No 1, p. 38-44. ISSN 2048-8726. Available from: https://dx.doi.org/10.1177/2048872617702505.

Basic information

Original name

Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study

Authors

KATAJA, Anu (246 Finland, guarantor), Tuukka TARVASMAKI (246 Finland), Johan LASSUS (246 Finland), Lars KOBER (208 Denmark), Alessandro SIONIS (724 Spain), Jindřich ŠPINAR (203 Czech Republic, belonging to the institution), John PARISSIS (300 Greece), Valentina CARUBELLI (380 Italy), Jose CARDOSO (620 Portugal), Marek BANASZEWSKI (616 Poland), Rossella MARINO (380 Italy), Markku S NIEMINEN (208 Denmark), Alexandre MEBAZAA (250 France) and Veli-Pekka HARJOLA (246 Finland)

Edition

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, LONDON, SAGE PUBLICATIONS LTD, 2018, 2048-8726

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Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 3.734

RIV identification code

RIV/00216224:14110/18:00104070

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1177/2048872617702505

UT WoS

000424643000005

Keywords in English

Cardiogenic shock; acute coronary syndromes; acute heart failure; altered mental status; delirium; acidosis

Tags

14110211, rivok

Tags

International impact, Reviewed

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Abstract

V originále

Background: Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock. Methods: Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status. Results: Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1-2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status. Conclusions: Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.