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Article Dans Une Revue Archives of Cardiovascular Diseases Année : 2024

Cardiogenic shock and infection: A lethal combination

Vincent Labbé
Eric Bonnefoy
Bruno Levy
Pascal Lim
Hadi Khachab
Gerald Vanzetto
  • Fonction : Auteur
Nicolas Combaret
Benjamin Marchandot
Benoît Lattuca
Laurent Bonello

Résumé

Background: Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock. Methods: FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1 year. Results: Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs 81.2%; P = 0.16), norepinephrine (72.5% vs 50.8%; P < 0.01), renal replacement therapy (29.7% vs 14%; P < 0.01), non-invasive ventilation (36.3% vs 24.4%; P = 0.09) and invasive ventilation (52.7% vs 35.9%; P = 0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs 24.0%; adjusted hazard ratio 1.94, 95% confidence interval 1.36–2.76; P < 0.01) and 1-year (62.0% vs 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32–2.33; P < 0.01) all-cause death rates. No significant difference was found at 1 year for heart transplantation or ventricular assistance device (8.7% vs 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32–1.64; P = 0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a pre-existing cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death. Conclusions: The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of pre-existing cardiomyopathy.
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Dates et versions

hal-04646570 , version 1 (12-07-2024)

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Miloud Cherbi, Hamid Merdji, Vincent Labbé, Eric Bonnefoy, Nicolas Lamblin, et al.. Cardiogenic shock and infection: A lethal combination. Archives of Cardiovascular Diseases, 2024, ⟨10.1016/j.acvd.2024.04.005⟩. ⟨hal-04646570⟩
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