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Abstract：
We sought to validate the Society for Cardiovascular Angiography and Interventions (SCAI) cardiogenic shock classification for mortality risk stratification in patients with sepsis and concomitant cardiovascular disease or mixed septic-cardiogenic shock. We conducted a single-center retropective cohort study of cardiac intensive care unit patients with an admission diagnosis of sepsis. We used clinical, vital sign, and laboratory data during the first 24 hours after admission to assign SCAI shock stage. We included 605 patients with a median age of 69.4 years (interquartile range, 57.9 to 79.8 years), 222 of whom (36.7%) were female. Acute coronary syndrome or heart failure was present in 480 patients (79.3%), and cardiogenic shock or cardiac arrest was present in 271 patients (44.8%). The median day 1 Sequential Organ Failure Assessment (SOFA) cardiovascular subscore was 1.5 (interquartile range, 1 to 4), and the admission SCAI shock stage distribution was stage B, 40.7% (246); stage C, 19.3% (117); stage D, 32.9% (199); and stage E, 7.1% (43). In-hospital mortality occurred in 177 of the 605 patients (29.3%) and increased incrementally with higher SCAI shock stage. After multivariable adjustment, admission SCAI shock stage was associated with in-hospital mortality (adjusted odds ratio per stage, 1.46; 95% CI, 1.14 to 1.88; P=.003). Admission SCAI shock stage had higher discrimination for in-hospital mortality than the day 1 SOFA cardiovascular subscore (area under the receiver operating characteristic curve, 0.68 vs 0.64; P=.04 by the DeLong test). Admission SCAI shock stage was associated with 1-year mortality (adjusted hazard ratio per stage, 1.19; 95% CI, 1.03 to 1.37; P=.02). The SCAI shock classification provides improved mortality risk stratification over the day 1 SOFA cardiovascular subscore in cardiac intensive care unit patients with sepsis and concomitant cardiovascular disease or mixed septic-cardiogenic shock.
摘要：
我们试图验证心血管造影和干预协会（SCAI）心源性休克分类在脓毒症和合并心血管疾病或感染性心源性休克混合性患者死亡风险分层中的应用。我们对入院诊断为败血症的心脏重症监护病房患者进行了一项单中心回顾性队列研究。我们用临床，生命体征,和入院后最初24小时的实验室数据，以分配SCAI休克阶段。我们纳入了605例患者，中位年龄为69.4岁(四分位距，57.9至79.8年），其中222人（36.7%）为女性。480例患者出现急性冠脉综合征或心力衰竭（79.3%），271例患者(44.8%)出现心源性休克或心脏骤停。第1天序贯器官衰竭评估（SOFA）心血管亚评分的中位数为1.5（四分位距，1至4），入院SCAI休克阶段分布为B阶段，40.7%(246)；C阶段，19.3%(117)；D阶段，32.9%(199)；和E阶段，7.1%（43）。605例患者中有177例（29.3％）发生院内死亡率，并且随着SCAI休克阶段的增加而增加。经过多变量调整后，入院SCAI休克阶段与住院死亡率相关(每个阶段的校正比值比，1.46；95%CI，1.14至1.88；P=.003）。入院SCAI休克阶段对住院死亡率的歧视高于第1天SOFA心血管子评分（受试者工作特征曲线下面积，0.68vs0.64；DeLong检验P=.04）。入院SCAI休克阶段与1年死亡率相关(每个阶段的校正风险比，1.19；95%CI，1.03至1.37；P=.02）。SCAI休克分类提供了在第1天SOFA心血管亚评分改善的死亡风险分层在心脏重症监护病房患者败血症和并发心血管疾病或混合败血症心源性休克。
