Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study

Anu Kataja; Tuukka Tarvasmäki; Johan Lassus; Lars Køber; Alessandro Sionis; Jindrich Spinar; John Parissis; Valentina Carubelli; Jose Cardoso; Marek Banaszewski; Rossella Marino; Markku S Nieminen; Alexandre Mebazaa; Veli-Pekka Harjola

doi:10.1177/2048872617702505

Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study

Anu Kataja, Tuukka Tarvasmäki, Johan Lassus, Lars Køber, Alessandro Sionis, Jindrich Spinar, John Parissis, Valentina Carubelli, Jose Cardoso, Marek Banaszewski, Rossella Marino, Markku S Nieminen, Alexandre Mebazaa, Veli-Pekka Harjola

Department of Clinical Medicine

8 Citations (Scopus)

Abstract

Background: Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock. Methods: Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status. Results: Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1–2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status. Conclusions: Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.

Original language	English
Journal	European Heart Journal: Acute Cardiovascular Care
Volume	7
Issue number	1
Pages (from-to)	38-44
Number of pages	7
ISSN	2048-8726
DOIs	https://doi.org/10.1177/2048872617702505
Publication status	Published - 1 Feb 2018

Keywords

Aged
Female
Finland/epidemiology
Heart Failure/complications
Humans
Male
Mental Health
Middle Aged
Prognosis
Prospective Studies
Risk Factors
Shock, Cardiogenic/etiology
Survival Rate/trends

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Kataja, A., Tarvasmäki, T., Lassus, J., Køber, L., Sionis, A., Spinar, J., Parissis, J., Carubelli, V., Cardoso, J., Banaszewski, M., Marino, R., Nieminen, M. S., Mebazaa, A., & Harjola, V-P. (2018). Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study. European Heart Journal: Acute Cardiovascular Care, 7(1), 38-44. https://doi.org/10.1177/2048872617702505

Kataja, A, Tarvasmäki, T, Lassus, J, Køber, L, Sionis, A, Spinar, J, Parissis, J, Carubelli, V, Cardoso, J, Banaszewski, M, Marino, R, Nieminen, MS, Mebazaa, A & Harjola, V-P 2018, 'Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study', European Heart Journal: Acute Cardiovascular Care, vol. 7, no. 1, pp. 38-44. https://doi.org/10.1177/2048872617702505

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abstract = "Background: Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock. Methods: Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status. Results: Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1–2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status. Conclusions: Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.",

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author = "Anu Kataja and Tuukka Tarvasm{\"a}ki and Johan Lassus and Lars K{\o}ber and Alessandro Sionis and Jindrich Spinar and John Parissis and Valentina Carubelli and Jose Cardoso and Marek Banaszewski and Rossella Marino and Nieminen, {Markku S} and Alexandre Mebazaa and Veli-Pekka Harjola",

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T1 - Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study

AU - Kataja, Anu

AU - Tarvasmäki, Tuukka

AU - Lassus, Johan

AU - Køber, Lars

AU - Sionis, Alessandro

AU - Spinar, Jindrich

AU - Parissis, John

AU - Carubelli, Valentina

AU - Cardoso, Jose

AU - Banaszewski, Marek

AU - Marino, Rossella

AU - Nieminen, Markku S

AU - Mebazaa, Alexandre

AU - Harjola, Veli-Pekka

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background: Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock. Methods: Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status. Results: Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1–2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status. Conclusions: Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.

AB - Background: Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock. Methods: Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status. Results: Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1–2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status. Conclusions: Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.

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KW - Female

KW - Finland/epidemiology

KW - Heart Failure/complications

KW - Humans

KW - Male

KW - Mental Health

KW - Middle Aged

KW - Prognosis

KW - Prospective Studies

KW - Risk Factors

KW - Shock, Cardiogenic/etiology

KW - Survival Rate/trends

U2 - 10.1177/2048872617702505

DO - 10.1177/2048872617702505

M3 - Journal article

C2 - 28403620

SN - 2048-8726

VL - 7

SP - 38

EP - 44

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

IS - 1

ER -

Altered mental status predicts mortality in cardiogenic shock - results from the CardShock study

Abstract

Keywords

UN SDGs

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