The Impact of Hemoglobin Trajectory on Clinical Outcomes in Severe Cardiogenic Shock: Insights from a Cohort Study

Background The aim of this study was to investigate the relationship between haemoglobin (Hb) trajectory and 28-day mortality in patients with critical CS. Methods We reviewed 1352 patients with critical CS in the Critical Care IV (MIMIC-IV) database, using latent class growth mixture model (LCGMM) to classify patients into 4 categories based on Hb trajectory (Class 1: “high-value-slow-decrease” class; Class 2: “consistent-low” class; Class 3: “high-value-fast-decrease” class; Class 4: “low-value-fast-increase” class). Prognostic analyses of the four groups of patients were performed using Kaplan-Meier curves, and the effect of Hb on 28-day mortality was explored using univariate and multivariate Cox regression models. Results We found that compared to the other three Classes, patients in Class 2 had the highest 28-day mortality [196 (34.8%) vs. 146 (26.5%), 50 (27.2%),14 (25.9%), P=0.016] and also had the highest in-hospital mortality, 90-day mortality, and 180-day mortality. After multifactorial Cox regression modelling, Hb levels were found to severely affect the patient's 28-day prognosis (HR 0.98, 95%CI 0.88, 1.08, P=0.035). Conclusions The 28-day mortality rate in patients with severe CS varies according to the trajectory of Hb levels (<9g/dL). Patients had the highest mortality when Hb levels were persistently low.