The following is a summary of “Serial Assessment of Shock Severity in Cardiac Intensive Care Unit Patients,” published in the November 2023 issue of Cardiology by Jentzer et al.

In the cardiac intensive care unit (CICU), the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification upon admission provides significant insights into mortality prediction. Their study aimed to explore whether the serial assessment of SCAI shock classification could enhance risk stratification among patients in the CICU. This retrospective cohort study involved unique admissions to an academic level 1 CICU between 2015 and 2018. Utilizing electronic health record data, researchers assigned SCAI shock stages within 4-hour intervals during the initial 24 hours of CICU admission. Shock, defined as hypoperfusion (SCAI shock stage C, D, or E), was examined in association with in-hospital mortality using logistic regression. Among 2,918 unique CICU patients, 52.7% met shock criteria during at least one 4-hour interval, with 9.1% experiencing in-hospital mortality. 

On admission, shock stages were distributed as follows: A (37.6%), B (31.5%), C (25.9%), D (1.8%), and E (3.3%). Patients meeting shock criteria on admission and those showing worsening shock stages post-admission faced higher in-hospital mortality risks. Increasing severity in admission, maximum, and mean SCAI shock stages were incrementally associated with heightened in-hospital mortality rates, with the mean SCAI shock stage demonstrating the highest discrimination (P<0.05). Furthermore, each additional 4-hour interval meeting SCAI shock criteria predicted an elevated mortality rate. Their findings underscore the value of serial assessment using SCAI shock classification in the CICU, enabling a more refined understanding of shock’s duration and magnitude to better predict patient mortality risks.

Source: ahajournals.org/doi/10.1161/JAHA.123.032748