Background:In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean patients with CS.Methods:The RESCUE study (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With CS) is a multicenter, retrospective, and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality.Results:In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and nonischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intraaortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multivariable analysis, age ≥70years (odds ratio [OR], 2.73 [95% CI, 1.89–3.94], P<0.001), body mass index <25 kg/m² (OR, 1.52 [95% CI, 1.08–2.16], P=0.017), cardiac arrest at presentation (OR, 2.16 [95% CI, 1.44–3.23], P<0.001), vasoactive-inotrope score >80 (OR, 3.55 [95% CI, 2.54–4.95], P<0.001), requiring continuous renal replacement therapy (OR, 4.14 [95% CI, 2.88–5.95], P<0.001), mechanical ventilator (OR, 3.17 [95% CI, 2.16–4.63], P<0.001), intraaortic balloon pump (OR, 1.55 [95% CI, 1.07–2.24], P=0.020), and extracorporeal membrane oxygenator (OR, 1.85 [95% CI, 1.25–2.76], P=0.002) were independent predictors for in-hospital mortality.Conclusions:The in-hospital mortality of patients with CS remains high despite the high utilization of mechanical circulatory support. Age, low body mass index, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure requiring various support devices were poor prognostic factors for in-hospital mortality.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.

中文翻译：

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心源性休克患者住院死亡率的临床特征和预测因素：RESCUE 登记的结果

背景：在当前机械循环支持时代，各种疾病引起的心源性休克（CS）的预后数据有限。我们调查了韩国 CS 患者院内死亡率的特征和预测因素。 ，以及出现 CS 的患者的前瞻性登记。2014 年 1 月至 2018 年 12 月期间，从韩国 12 个主要中心招募了 1247 名 CS 患者。主要结局为院内死亡率。结果：院内死亡率为33.6%。休克的主要原因是缺血性心脏病（80.7%）、扩张型心肌病（6.1%）、心肌炎（3.2%）、和非缺血性室性心律失常 (2.5%)。1081 名患者（86.7%）使用了血管加压药。最常用的血管加压药是多巴胺 (63.4%)，其次是去甲肾上腺素 (57.3%)。314 名患者（25.2%）使用了主动脉内球囊泵，496 名患者（39.8%）使用了体外膜肺氧合器。在多变量分析中，年龄≥70 岁（优势比 [OR]，2.73 [95% CI，1.89–3.94]，P <0.001)，体重指数 <25 kg/m ² (OR, 1.52 [95% CI, 1.08–2.16], P = 0.017)，就诊时心脏骤停 (OR, 2.16 [95% CI, 1.44–3.23] , P <0.001), 血管活性肌力药评分 >80 (OR, 3.55 [95% CI, 2.54–4.95], P <0.001), 需要连续肾脏替代治疗 (OR, 4.14 [95% CI, 2.88–5.95], P <0.001）、机械呼吸机（OR，3.17 [95% CI，2.16-4.63]，P <0.001），主动脉内球囊泵（OR，1.55 [95% CI，1.07-2.24]，P = 0.020）和体外膜式氧合器（OR, 1.85 [95% CI, 1.25–2.76], P=0.002) 是院内死亡率的独立预测因子。结论：尽管机械循环支持的利用率很高，但 CS 患者的院内死亡率仍然很高。年龄、体重指数低、就诊时心脏骤停、血管加压药用量和需要各种支持装置的晚期器官衰竭是院内死亡率的不良预后因素。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT02985008。