Cardiogenic shock ups risk of death in hospitalized children with ADHF

Nearly one in four children hospitalized for acute decompensated heart failure (ADHF) had cardiogenic shock (CS), which may lead to death, reports a study.

Researchers assessed consecutive ADHF hospitalizations (<21 years of age) from a large single-centre retrospective cohort. They analysed patients with CS at presentation and identified risk factors for CS and for in-hospital mortality, the primary outcome.

Subsequently, the research team created a modified Society for Cardiovascular Angiography and Interventions shock classification and staged patients accordingly.

In total, 803 hospitalizations for ADHF were documented in 591 patients (median age 7.6 years), of which 207 (26 percent) had CS. ADHF hospitalizations with CS, compared to those without CS, were characterized by the following: worse systolic function (p=0.040), higher B-type natriuretic peptide concentration (p=0.032), and more frequent early severe renal (p=0.023) and liver (p<0.001) injury.

Children who presented with CS more frequently received mechanical ventilation (87 percent vs 26 percent) and mechanical circulatory support (45 percent vs 16 percent; p<0.001 for both).

In the analysis of the most recent ADHF hospitalization, children with CS showed a higher risk of in-hospital death compared with those without CS (28 percent vs 11 percent; odds ratio [OR], 1.91, 95 percent confidence interval [CI], 1.05‒3.45; p=0.033). Additionally, each higher CS stage correlated with greater inpatient mortality (OR, 2.40‒8.90; p<0.001 for all).

“A modified Society for Cardiovascular Angiography and Interventions classification for CS severity showed robust association with increasing mortality,” the researchers said.