Prognostic Value of Neurological Status on Hospital Arrival for Short-Term Outcome in Patients With Cardiovascular Shock - Sub-analysis of the Japanese Circulation Society Cardiovascular Shock Registry

Japanese Circulation Society Shock Registry Scientific Committee

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Consciousness disturbance is one of the major clinical signs associated with shock state, but its prognostic value has not been previously evaluated in cardiovascular shock patients. We aimed to evaluate the prognostic value of neurological status for 30-day mortality in cardiovascular shock patients without out-of-hospital cardiac arrest (OHCA). Methods and Results: Patients with out-of-hospital onset cardiovascular shock were recruited from the Japanese Circulation Society Shock Registry. Neurological status upon hospital arrival was evaluated using the Japan Coma Scale (JCS). Patients were divided into 4 groups according to the JCS: alert, JCS 0; awake, JCS 1-3 (not fully alert but awake without any stimuli); arousable, JCS 10-30 (arousable with stimulation); and coma JCS 100-300 (unarousable). The primary endpoint was 30-day all-cause death. In total, 700 cardiovascular shock patients without OHCA were assessed. The coma group was associated with a higher incidence of 30-day all-cause death compared with other groups (alert, 15.3%; awake, 24.4%; arousable, 36.8%; coma, 48.5%, P<0.001). Similar trends were observed in etiologically divergent subgroups (acute coronary syndrome, non-ischemic arrhythmia, and aortic disease). On multivariate Cox regression analysis, arousable (hazard ratio [HR], 1.82; 95% CI: 1.16-2.85, P=0.009) and coma (HR, 2.72; 95% CI: 1.76-4.22, P<0.001) (reference: alert) independently predicted 30-day mortality.

CONCLUSIONS: Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA.

Original languageEnglish
Pages (from-to)1247-1253
Number of pages7
JournalCirculation journal : official journal of the Japanese Circulation Society
Volume83
Issue number6
DOIs
Publication statusPublished - Apr 3 2019

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Coma
Registries
Shock
Japan
Out-of-Hospital Cardiac Arrest
Mortality
Cause of Death
Aortic Diseases
Acute Coronary Syndrome
Consciousness
Cardiac Arrhythmias
Regression Analysis
Incidence

Cite this

@article{b53f4a66dc374452aa910a172bb43b86,
title = "Prognostic Value of Neurological Status on Hospital Arrival for Short-Term Outcome in Patients With Cardiovascular Shock - Sub-analysis of the Japanese Circulation Society Cardiovascular Shock Registry",
abstract = "BACKGROUND: Consciousness disturbance is one of the major clinical signs associated with shock state, but its prognostic value has not been previously evaluated in cardiovascular shock patients. We aimed to evaluate the prognostic value of neurological status for 30-day mortality in cardiovascular shock patients without out-of-hospital cardiac arrest (OHCA). Methods and Results: Patients with out-of-hospital onset cardiovascular shock were recruited from the Japanese Circulation Society Shock Registry. Neurological status upon hospital arrival was evaluated using the Japan Coma Scale (JCS). Patients were divided into 4 groups according to the JCS: alert, JCS 0; awake, JCS 1-3 (not fully alert but awake without any stimuli); arousable, JCS 10-30 (arousable with stimulation); and coma JCS 100-300 (unarousable). The primary endpoint was 30-day all-cause death. In total, 700 cardiovascular shock patients without OHCA were assessed. The coma group was associated with a higher incidence of 30-day all-cause death compared with other groups (alert, 15.3{\%}; awake, 24.4{\%}; arousable, 36.8{\%}; coma, 48.5{\%}, P<0.001). Similar trends were observed in etiologically divergent subgroups (acute coronary syndrome, non-ischemic arrhythmia, and aortic disease). On multivariate Cox regression analysis, arousable (hazard ratio [HR], 1.82; 95{\%} CI: 1.16-2.85, P=0.009) and coma (HR, 2.72; 95{\%} CI: 1.76-4.22, P<0.001) (reference: alert) independently predicted 30-day mortality.CONCLUSIONS: Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA.",
author = "{Japanese Circulation Society Shock Registry Scientific Committee} and Yasushi Ueki and Masahiro Mohri and Tetsuya Matoba and Toshiaki Kadokami and Satoru Suwa and Tsukasa Yagi and Hiroshi Takahashi and Nobuhiro Tanaka and Yohei Hokama and Rei Fukuhara and Ken Onitsuka and Eizo Tachibana and Naohiro Yonemoto and Ken Nagao",
year = "2019",
month = "4",
day = "3",
doi = "10.1253/circj.CJ-18-1323",
language = "English",
volume = "83",
pages = "1247--1253",
journal = "Circulation Journal",
issn = "1346-9843",
publisher = "Japanese Circulation Society",
number = "6",

}

TY - JOUR

T1 - Prognostic Value of Neurological Status on Hospital Arrival for Short-Term Outcome in Patients With Cardiovascular Shock - Sub-analysis of the Japanese Circulation Society Cardiovascular Shock Registry

AU - Japanese Circulation Society Shock Registry Scientific Committee

AU - Ueki, Yasushi

AU - Mohri, Masahiro

AU - Matoba, Tetsuya

AU - Kadokami, Toshiaki

AU - Suwa, Satoru

AU - Yagi, Tsukasa

AU - Takahashi, Hiroshi

AU - Tanaka, Nobuhiro

AU - Hokama, Yohei

AU - Fukuhara, Rei

AU - Onitsuka, Ken

AU - Tachibana, Eizo

AU - Yonemoto, Naohiro

AU - Nagao, Ken

PY - 2019/4/3

Y1 - 2019/4/3

N2 - BACKGROUND: Consciousness disturbance is one of the major clinical signs associated with shock state, but its prognostic value has not been previously evaluated in cardiovascular shock patients. We aimed to evaluate the prognostic value of neurological status for 30-day mortality in cardiovascular shock patients without out-of-hospital cardiac arrest (OHCA). Methods and Results: Patients with out-of-hospital onset cardiovascular shock were recruited from the Japanese Circulation Society Shock Registry. Neurological status upon hospital arrival was evaluated using the Japan Coma Scale (JCS). Patients were divided into 4 groups according to the JCS: alert, JCS 0; awake, JCS 1-3 (not fully alert but awake without any stimuli); arousable, JCS 10-30 (arousable with stimulation); and coma JCS 100-300 (unarousable). The primary endpoint was 30-day all-cause death. In total, 700 cardiovascular shock patients without OHCA were assessed. The coma group was associated with a higher incidence of 30-day all-cause death compared with other groups (alert, 15.3%; awake, 24.4%; arousable, 36.8%; coma, 48.5%, P<0.001). Similar trends were observed in etiologically divergent subgroups (acute coronary syndrome, non-ischemic arrhythmia, and aortic disease). On multivariate Cox regression analysis, arousable (hazard ratio [HR], 1.82; 95% CI: 1.16-2.85, P=0.009) and coma (HR, 2.72; 95% CI: 1.76-4.22, P<0.001) (reference: alert) independently predicted 30-day mortality.CONCLUSIONS: Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA.

AB - BACKGROUND: Consciousness disturbance is one of the major clinical signs associated with shock state, but its prognostic value has not been previously evaluated in cardiovascular shock patients. We aimed to evaluate the prognostic value of neurological status for 30-day mortality in cardiovascular shock patients without out-of-hospital cardiac arrest (OHCA). Methods and Results: Patients with out-of-hospital onset cardiovascular shock were recruited from the Japanese Circulation Society Shock Registry. Neurological status upon hospital arrival was evaluated using the Japan Coma Scale (JCS). Patients were divided into 4 groups according to the JCS: alert, JCS 0; awake, JCS 1-3 (not fully alert but awake without any stimuli); arousable, JCS 10-30 (arousable with stimulation); and coma JCS 100-300 (unarousable). The primary endpoint was 30-day all-cause death. In total, 700 cardiovascular shock patients without OHCA were assessed. The coma group was associated with a higher incidence of 30-day all-cause death compared with other groups (alert, 15.3%; awake, 24.4%; arousable, 36.8%; coma, 48.5%, P<0.001). Similar trends were observed in etiologically divergent subgroups (acute coronary syndrome, non-ischemic arrhythmia, and aortic disease). On multivariate Cox regression analysis, arousable (hazard ratio [HR], 1.82; 95% CI: 1.16-2.85, P=0.009) and coma (HR, 2.72; 95% CI: 1.76-4.22, P<0.001) (reference: alert) independently predicted 30-day mortality.CONCLUSIONS: Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA.

U2 - 10.1253/circj.CJ-18-1323

DO - 10.1253/circj.CJ-18-1323

M3 - Article

C2 - 30944275

VL - 83

SP - 1247

EP - 1253

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 6

ER -