Analysis Of Prognostic Risk Factors In Patients With Cardiogenic Shock

Objective: To explore the risk factors affecting the prognosis of patients with cardiogenic shock(CS),and to provide evidence for further reducing the mortality of patients with CS.Methods : From January 2010 to December 2017,the clinical data of 90 patients diagnosed as CS in the Department of Emergency Medicine and Department of Cardiology,the first affiliated Hospital of Anhui Medical University,were collected and analyzed retrospectively.According to the survival and death of the patients during hospitalization(within 28 days),all patients were divided into survival group and death group,and the indexes related to the prognosis of patients with CS were screened by univariate analysis.The independent risk factors affecting the prognosis of patients with CS were screened by multivariate Logistic regression model.Evaluation of predictive efficacy of continuous variables for poor prognosis of patients with CS using the receiver operating characteristic(ROC)curve,the results were described quantitatively by the area under the curve.In addition,in order to further explore the impact of acute myocardial infarction(AMI)on the risk of death in patients with CS during hospitalization,the patients were divided into AMI group and non-AMI group according to whether or not they were complicated with AMI,the same as described above.First,the baseline data of the two groups were analyzed by univariate analysis,and then the statistically significant indexes were included in the multivariate COX regression analysis to screen out the independent indicators related to the risk of death during hospitalization in CS patients.Adoption Bilateral test,it's considered that the difference was statistically significant,when P < 0.05.Results: The incidence of(AMI),in 50 patients with acute myocardial infarction(AMI)was 55.6% among 90 patients with CS.Among non-AMI patients,severe cardiomyopathy accounted for 11.1%,severe myocarditis 12.2%,valvular heart disease16.7%,septal perforation 2.9%,Other diseases 15.6%.68 cases(75.6%)died during hospitalization.Univariate analysis showed that age,AMI,cardiomyopathy,diabetes mellitus,malignant arrhythmias,systolic blood pressure,diastolic blood pressure,troponin,creatine kinase isoenzyme and brain natriuretic peptide were found in survival and death groups.There were significant differences between the two groups in the levels of 0-hour,6-hour,24-hour,48-hour,72-hour,PCI and PICCO(P < 0.05).These statistically significant indicators were included in the multivariate Logistic regression analysis,and the results showed that age,combined with acute myocardial infarction,diabetes,Troponin(cTnI)is an independent risk factor affecting the prognosis of patients with CS.Roc curve analysis shows that both age and cTnI have certain value in predicting poor prognosis of patients with CS.AUC were 0.655,0.710.When the sum of sensitivity and specificity was taken as the maximum value,the best cut-off value of cTnI was 66 years old and 5.28 ug / L,respectively,and the sensitivity was 77.3% and72% respectively.The specificity was 80.7% and 79.2% respectively.COX regression analysis showed that age,acute myocardial infarction(AMI),diabetes mellitus,and troponin(cTnI)were independently associated with the risk of death during hospitalization in CS patients.Conclusion:(1)AMI accounted for 55.6% of CS,which was the main cause of CS.(2)Age associated with AMI,diabetes mellitus,cardiac troponin is an independent risk factor for poor prognosis in CS patients,and increases the risk of death during hospitalization.(3)Age and troponin have certain clinical value in predicting the bad prognosis of patients with CS.