https://doi.org/10.1007/s00392-025-02625-4
1Universitäts-Herzzentrum Freiburg - Bad Krozingen Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; 2Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland; 3Universitäts-Herzzentrum Freiburg - Bad Krozingen Klinik für Kardiologie und Angiologie Freiburg im Breisgau, Deutschland
Cardiogenic shock (CS) is a complex syndrome with high mortality. The Society for Cardiovascular Angiography and Interventions (SCAI) criteria are an established method for stratifying the severity of cardiogenic shock at initial presentation. However, factors predicting mortality in cardiogenic shock patients who survive the first 24 hours are less well understood.
Methods
Consecutive cardiogenic shock (CS) patients categorized as SCAI ≥ B presenting to the University Hospital Freiburg (Bad Krozingen and Freiburg sites) in the years 2018 to 2023, who survived the first 24h, were retrospectively analyzed. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to identify relevant predictors of in-hospital mortality from 53 variables of potential interest. Receiver Operating Characteristic (ROC) analysis assessed the predictive capacity of the key predictors.
Results
The analysis included 137 patients who survived at least 24h. For descriptive analyses, patients were stratified by median 24h-UO (1510 ml/24h). Post-day one in-hospital mortality was higher in the below-median 24h-UO group (58.8% vs. 27.5%, p<0.001). Patients with lower 24h-UO were older, had higher BMI, and more often chronic kidney disease (all p < 0.05). The etiology of CS, the SCAI-classification at index event, and the prevalence of cardiac arrest did not differ between the groups.
In an unbiased LASSO regression analysis, 24-hour urinary output (24h-UO) was identified as a predictor of in-hospital mortality among patients who survived the first 24 hours of cardiogenic shock (CS). Normalized to body surface area, 24h-UO showed an odds ratio (OR) of 0.68 (95% CI: 0.49–0.90, p = 0.012) for in-hospital mortality. After adjustment for age, peak lactate within the first 24 hours, and SCAI classification at 24 hours, the OR was 0.76 (95% CI: 0.54–1.01, p = 0.069). Oliguria, defined as urinary output below 500 ml in the first 24 hours, was associated with an OR of 3.37 (95% CI: 1.42–8.51, p = 0.007) for in-hospital mortality. The adjusted OR for oliguria was 2.76 (95% CI: 1.04–7.77, p = 0.046). In ROC analyses, 24h-UO had modest predictive capacity (AUC: 0.68), in the range of established risk estimators, such as SCAI classification at 24h (0.70), and worst lactate during the first 24h (0.68). Combining SCAI at 24h and 24h-UO showed a higher AUC compared to each individual factor (AUC: 0.76).
Conclusion
These retrospective data suggest that 24-hour urine output is associated with in-hospital mortality in day one survivors of cardiogenic shock. The suboptimal performance of all analyzed markers highlights the critical need for further prospective trials to improve prognostic accuracy in patients with cardiogenic shock.