Accuracy of different scoring systems in cardiogenic shock patients treated with micro-axial percutaneous left ventricular assist device
Authors: Mierke J , Nowack T , Schuster M C , Botan R , Winkler A , Sveric K , Woitek F J , Haussig S , Linke A , Mangner N 
Published: November 2023

Abstract

Background
Cardiogenic shock (CS) is the most severe form of acute heart failure characterized by high mortality. Micro-axial percutaneous left ventricular assist devices (pLVAD) might improve outcome. The utilization of these devices increased lately but is associated with high material and personnel costs and unknown impact on prognosis. Therefore, a precise assessment of prognosis is of immanent interest to determine upfront, who might benefit from the device. For this purpose, different scoring systems were developed.

Purpose
In the current study, we investigated accuracy of 9 different scoring systems predicting all-cause mortality at 30 days.

Methods
Data were collected from our ongoing Impella registry including more than 740 patients treated for different indications since 2014. Among them, 434 patients received a micro-axial pLVAD in CS. Acute Physiology and Chronic Health Evaluation (APACHE) II score (APA), Simplified Acute Physiology Score II (SAPS), Multiple Organ Dysfunction Score (MODS), Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction System (LODS) score, Organ Dysfunctions or Infection score (ODIN), ENCOURAGE score, CardShock score, and IABP-SHOCK II risk score were calculated. All-cause mortality was characterized with the use of Kaplan-Meier plots. A receiver operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was estimated to determine the predictive value of the different scores for 30-day-mortality. Subgroup analyses were performed for CS caused by acute myocardial infarction (AMI), CS caused not by AMI, and cardiopulmonary resuscitation (CPR).

Results
Patients were 68±1 years old with predominance of male gender (73.5% [n=319]). CS was mainly caused by AMI (55.8% [n=242]). A CPR before pLVAD was performed in 49.5% [n=215] with a mean duration of 36±3 minutes. Initial serum lactate was 7.5±0.3 mmol/l. Further baseline characteristics are shown in Table 1. All-cause mortality at 30 days was 65.0±2.3% (Figure 1A). Survivors’ mean stay at hospital was 18±3 days. ROC analyses revealed a positive prediction of 30-day-mortality of all scores (Figure 1B). The SAPS showed the best, ODIN and IABP-SHOCK II risk score the lowest accuracies (ROC AUC [95% CI] SAPS 0.757 [0.704-0.810; p&lt;0.001], ODIN 0.647 [0.585-0.708; p&lt;0.001], IABP SHOCK II 0.649 [0.588-0.709; p&lt;0.001]). In the subgroup analyses, comparable results were reached except for patients receiving a CPR. Among those patients, only SAPS, LODS and ENCOURAGE score significantly predicted 30-day-mortality, but accuracies were low (Figure 1C).

Conclusion
In CS patients treated with pLVAD, the examined scoring systems significantly predicted 30-day-mortality with relevant differences in accuracy. The best prediction was revealed by SAPS. None of the scores showed an acceptable prediction in patients receiving a CPR indicating a specific patient cohort in need for better prognostic tools.Table 1Figure 1