Clinical Course and Outcomes of Cardiogenic Shock in COVID-19 : Insights from COVID-19 Critical Care Consortium

Aim: Cardiogenic shock (CS) is a life-threatening condition observed in patients with severe heart diseases. Although COVID-19 is known to cause cardiac complications, the epidemiology and outcomes of CS in COVID-19 patients have not been characterised. This study aimed to describe the prevalence, clinical course, mortality, and patient characteristics associated with CS in COVID-19 patients admitted to intensive care units (ICUs). Methods: We retrospectively analysed the Cardiac Sub-study database of the COVID-19 Critical Care Consortium. Local physicians diagnosed CS at ICU admission based on persistent hypotension combined with evidence of low cardiac output and elevated filling pressures. We also evaluated the applicability of the Society for Cardiovascular Angiography and Interventions (SCAI) CS staging system for mortality prediction. Results: Among 780 patients, 74 (9.5%) were diagnosed with CS, and their 30-day mortality rate was significantly higher than that of patients without CS (56.8% vs 33.4%; P <0.001). The common cardiac complications in patients with CS were arrhythmia (58.1%), congestive heart failure (35.1%), and myocardial infarction (18.9%). On multivariable analysis, history of ventricular arrhythmia was the sole independent factor associated with CS complication (odds ratio 3.9; 95% confidence interval [CI], 1.6–9.5). Among patients with CS, 43 were classified into SCAI stages C/D, and 31 into stage E. Stage E was associated with significantly higher mortality (74.2% vs. 44.2%; hazard ratio 2.2; 95% CI, 1.4-4.0). Conclusion: CS was observed in 9.5% of critically ill COVID-19 cases, which was significantly associated with elevated mortality. SCAI staging effectively stratified mortality risk in this population.