Jacob C Jentzer1,2, Patrick R Lawler3,4,5, Sean van Diepen6,7, Timothy D Henry8, Venu Menon9, David A Baran10, Vladimír Džavík3, Gregory W Barsness1, David R Holmes1, Kianoush B Kashani2,11. 1. Department of Cardiovascular Medicine (J.C.J., G.W.B., D.R.H.), Mayo Clinic, Rochester, MN. 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.C.J., K.B.K.), Mayo Clinic, Rochester, MN. 3. Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (P.R.L., V.D.). 4. Ted Rogers Centre for Heart Research, Toronto, Canada (P.R.L.). 5. Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (P.R.L.). 6. Department of Critical Care Medicine, Division of Cardiology (S.v.D.), University of Alberta Hospital, Edmonton. 7. Department of Medicine (S.v.D.), University of Alberta Hospital, Edmonton. 8. The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital Health Network, Cincinnati, OH (T.D.H.). 9. Department of Cardiovascular Medicine, Cleveland Clinic, OH (V.M.). 10. Sentara Heart Hospital, Advanced Heart Failure Center and Eastern Virginia Medical School, Norfolk (D.A.B.). 11. Division of Nephrology and Hypertension, Department of Internal Medicine (K.B.K.), Mayo Clinic, Rochester, MN.
Abstract
BACKGROUND: The systemic inflammatory response syndrome (SIRS) frequently occurs in patients with cardiogenic shock and may aggravate shock severity and organ failure. We sought to determine the association of SIRS with illness severity and survival across the spectrum of shock severity in cardiac intensive care unit (CICU) patients. METHODS: We retrospectively analyzed 8995 unique patients admitted to the Mayo Clinic CICU between 2007 and 2015. Patients with ≥2/4 SIRS criteria based on admission laboratory and vital sign data were considered to have SIRS. Patients were stratified by the 2019 Society for Cardiovascular Angiography and Interventions (SCAI) shock stages using admission data. The association between SIRS and mortality was evaluated across SCAI shock stage using logistic regression and Cox proportional-hazards models for hospital and 1-year mortality, respectively. RESULTS: The study population had a mean age of 67.5±15.2 years, including 37.2% women. SIRS was present in 33.9% of patients upon CICU admission and was more prevalent in advanced SCAI shock stages. Patients with SIRS had higher illness severity, worse shock, and more organ failure, with an increased risk of mortality during hospitalization (16.8% versus 3.8%; adjusted odds ratio, 2.1 [95% CI, 1.7-2.5]; P<0.001) and at 1 year (adjusted hazard ratio, 1.4 [95% CI, 1.3-1.6]; P<0.001). After multivariable adjustment, SIRS was associated with higher hospital and 1-year mortality among patients in SCAI shock stages A through D (all P<0.01) but not SCAI shock stage E. CONCLUSIONS: One-third of CICU patients meet clinical criteria for SIRS at the time of admission, and these patients have higher illness severity and worse outcomes across the spectrum of SCAI shock stages. The presence of SIRS identified CICU patients at increased risk of short-term and long-term mortality. Further study is needed to determine whether systemic inflammation truly drives SIRS in this population and whether patients with SIRS respond differently to supportive therapies for shock.
BACKGROUND: The systemic inflammatory response syndrome (SIRS) frequently occurs in patients with cardiogenic shock and may aggravate shock severity and organ failure. We sought to determine the association of SIRS with illness severity and survival across the spectrum of shock severity in cardiac intensive care unit (CICU) patients. METHODS: We retrospectively analyzed 8995 unique patients admitted to the Mayo Clinic CICU between 2007 and 2015. Patients with ≥2/4 SIRS criteria based on admission laboratory and vital sign data were considered to have SIRS. Patients were stratified by the 2019 Society for Cardiovascular Angiography and Interventions (SCAI) shock stages using admission data. The association between SIRS and mortality was evaluated across SCAI shock stage using logistic regression and Cox proportional-hazards models for hospital and 1-year mortality, respectively. RESULTS: The study population had a mean age of 67.5±15.2 years, including 37.2% women. SIRS was present in 33.9% of patients upon CICU admission and was more prevalent in advanced SCAI shock stages. Patients with SIRS had higher illness severity, worse shock, and more organ failure, with an increased risk of mortality during hospitalization (16.8% versus 3.8%; adjusted odds ratio, 2.1 [95% CI, 1.7-2.5]; P<0.001) and at 1 year (adjusted hazard ratio, 1.4 [95% CI, 1.3-1.6]; P<0.001). After multivariable adjustment, SIRS was associated with higher hospital and 1-year mortality among patients in SCAI shock stages A through D (all P<0.01) but not SCAI shock stage E. CONCLUSIONS: One-third of CICU patients meet clinical criteria for SIRS at the time of admission, and these patients have higher illness severity and worse outcomes across the spectrum of SCAI shock stages. The presence of SIRS identified CICU patients at increased risk of short-term and long-term mortality. Further study is needed to determine whether systemic inflammation truly drives SIRS in this population and whether patients with SIRS respond differently to supportive therapies for shock.
Authors: Jacob C Jentzer; Sean van Diepen; Steven M Hollenberg; Patrick R Lawler; Kianoush B Kashani Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-12-23
Authors: Jacob C Jentzer; Anusha G Bhat; Sri Harsha Patlolla; Shashank S Sinha; P Elliott Miller; Patrick R Lawler; Sean van Diepen; Ashish K Khanna; David X Zhao; Saraschandra Vallabhajosyula Journal: Crit Care Explor Date: 2022-02-04