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 ―

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  • Ueki Yasushi
    The Japanese Circulation Society Shock Registry Scientific Committee Emergency and Critical Care Center, Shinshu University School of Medicine
  • Mohri Masahiro
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital
  • Matoba Tetsuya
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiovascular Medicine, Kyushu University Hospital
  • Kadokami Toshiaki
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Saiseikai Futsukaichi Hospital
  • Suwa Satoru
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Juntendo University Shizuoka Hospital
  • Yagi Tsukasa
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Kawaguchi Municipal Medical Center
  • Takahashi Hiroshi
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Steel Memorial Muroran Hospital
  • Tanaka Nobuhiro
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Tokyo Medical University Hachioji Medical Center
  • Hokama Yohei
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Tokyo Medical University Hachioji Medical Center
  • Fukuhara Rei
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
  • Onitsuka Ken
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital
  • Tachibana Eizo
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Cardiology, Kawaguchi Municipal Medical Center
  • Yonemoto Naohiro
    The Japanese Circulation Society Shock Registry Scientific Committee Department of Biostatistics, Kyoto University School of Public Health
  • Nagao Ken
    The Japanese Circulation Society Shock Registry Scientific Committee Cardiovascular Center, Nihon University Hospital
  • for the Japanese Circulation Society Shock Registry Scientific Committee

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抄録

<p>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). </p><p>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. </p><p>Conclusions: Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA. </p>

収録刊行物

  • Circulation Journal

    Circulation Journal 83 (6), 1247-1253, 2019-05-24

    一般社団法人 日本循環器学会

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