Abstract：
BACKGROUND: There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients.
METHODS: We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality.
RESULTS: There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% versus 29.4%) and have peripheral arterial disease (13.8% versus 8.3%). Stratified by maximum SCAI shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53 - 3.23; p < 0.01) and ≥ 2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24 - 2.21, p < 0.01). ALI was highest for VA-ECMO patients (11.6%) or VA-ECMO + IABP/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01 - 1.95, p < 0.01).
CONCLUSIONS: The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.
METHODS: We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality.
RESULTS: There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% versus 29.4%) and have peripheral arterial disease (13.8% versus 8.3%). Stratified by maximum SCAI shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53 - 3.23; p < 0.01) and ≥ 2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24 - 2.21, p < 0.01). ALI was highest for VA-ECMO patients (11.6%) or VA-ECMO + IABP/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01 - 1.95, p < 0.01).
CONCLUSIONS: The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.
摘要：
背景：关于心源性休克（CS）患者急性肢体缺血（ALI）的患病率和后果的数据有限。
方法：我们采用了心源性休克工作组（CSWG）的数据，一个财团，包括33个站点。我们构建了一个多变量logistic回归，以检查临床因素与ALI之间的关联。我们建立了另一个逻辑回归模型来确定ALI与死亡率的相关性.
结果：有7,070例CS患者和399例（5.6％）发生ALI。患有ALI的患者更可能是女性(40.4%对29.4%)并且患有外周动脉疾病(13.8%对8.3%)。按最大SCAI冲击阶段分层，ALI的发生率为B期0.0%，阶段C1.8%，D阶段4.1%，和E阶段10.3%。与ALI高风险相关的因素包括：外周血管疾病OR2.24（95％CI：1.53-3.23；p<0.01）和≥2个机械循环支持（MCS）设备OR1.66（95％CI：1.24-2.21，p<0.01）。VA-ECMO患者（11.6％）或VA-ECMOIABP/ImpellaCP（16.6％）的ALI最高，但使用远端灌注导管的比例低于50％。无ALI的CS患者死亡率为38.0%，有ALI的CS患者死亡率为57.4%。ALI与死亡率显著相关，校正OR1.40（95%CI1.01-1.95，p<0.01）。
结论：CS患者ALI的发生率为6%。与ALI最相关的因素包括外周血管疾病和多种MCS设备。ALI的下游分支是可怕的，死亡风险相当高。
方法：我们采用了心源性休克工作组（CSWG）的数据，一个财团，包括33个站点。我们构建了一个多变量logistic回归，以检查临床因素与ALI之间的关联。我们建立了另一个逻辑回归模型来确定ALI与死亡率的相关性.
结果：有7,070例CS患者和399例（5.6％）发生ALI。患有ALI的患者更可能是女性(40.4%对29.4%)并且患有外周动脉疾病(13.8%对8.3%)。按最大SCAI冲击阶段分层，ALI的发生率为B期0.0%，阶段C1.8%，D阶段4.1%，和E阶段10.3%。与ALI高风险相关的因素包括：外周血管疾病OR2.24（95％CI：1.53-3.23；p<0.01）和≥2个机械循环支持（MCS）设备OR1.66（95％CI：1.24-2.21，p<0.01）。VA-ECMO患者（11.6％）或VA-ECMOIABP/ImpellaCP（16.6％）的ALI最高，但使用远端灌注导管的比例低于50％。无ALI的CS患者死亡率为38.0%，有ALI的CS患者死亡率为57.4%。ALI与死亡率显著相关，校正OR1.40（95%CI1.01-1.95，p<0.01）。
结论：CS患者ALI的发生率为6%。与ALI最相关的因素包括外周血管疾病和多种MCS设备。ALI的下游分支是可怕的，死亡风险相当高。
