NYMC Faculty Publications
Defining Shock and Preshock for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients
Author Type(s)
Faculty
DOI
10.1161/CIRCHEARTFAILURE.120.007678
Journal Title
Circulation. Heart Failure
First Page
007678
Last Page
007678
Document Type
Article
Publication Date
1-2021
Department
Medicine
Abstract
BACKGROUND: Previous studies have defined preshock as isolated hypotension or isolated hypoperfusion, whereas shock has been variably defined as hypoperfusion with or without hypotension. We aimed to evaluate the mortality risk associated with hypotension and hypoperfusion at the time of admission in a cardiac intensive care unit population.
METHODS: We analyzed Mayo Clinic cardiac intensive care unit patients admitted between 2007 and 2015. Hypotension was defined as systolic blood pressureHg, and hypoperfusion as admission lactate >2 mmol/L, oliguria, or rising creatinine. Associations between hypotension and hypoperfusion with hospital mortality were estimated using multivariable logistic regression.
RESULTS: Among 10 004 patients with a median age of 69 years, 43.1% had acute coronary syndrome, and 46.1% had heart failure. Isolated hypotension was present in 16.7%, isolated hypoperfusion in 15.3%, and 8.7% had both hypotension and hypoperfusion. Stepwise increases in hospital mortality were observed with hypotension and hypoperfusion compared with neither hypotension nor hypoperfusion (3.3%; all
CONCLUSIONS: Hypotension and hypoperfusion are both associated with increased mortality in cardiac intensive care unit patients. Hospital mortality is higher with isolated hypoperfusion or concomitant hypotension and hypoperfusion (classic shock). We contend that preshock should refer to isolated hypotension without hypoperfusion, while patients with hypoperfusion can be considered to have shock, irrespective of blood pressure.
Recommended Citation
Jentzer, J. C., Burstein, B., Van Diepen, S., Murphy, J., Holmes, D. R., Bell, M. R., Barsness, G. W., Henry, T. D., Menon, V., Rihal, C. S., Naidu, S. S., & Baran, D. A. (2021). Defining Shock and Preshock for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients. Circulation. Heart Failure, 14 (1), 007678-007678. https://doi.org/10.1161/CIRCHEARTFAILURE.120.007678