Abstract Body (Do not enter title and authors here):
Background: Cardiogenic shock (CS) is a condition in which cardiac dysfunction results in extensive hypoperfusion. While CS alone is life-threatening, it can be further exacerbated by infection which occurs in around 20% of CS hospitalizations. Management of these complications requires greater resource utilization and may lead to increased risk of organ failure. There is limited research on the outcomes of concomitant infection in CS. We aimed to examine the impact of concomitant infections as well as focus on the subgroup of CS requiring temporary mechanical circulatory support (tMCS).
Methods: Patients with a diagnosis of CS within a quaternary academic medical center between 2021 to 2025 were analyzed. Patients were categorized based on the presence of infection during the CS hospitalization. Concomitant infection was defined as a positive culture from any source requiring greater than 72 hours of antibiotic treatment. Outcomes included length of total hospitalization and ICU stay, duration of mechanical ventilation (MV), and tMCS usage. Groups were compared using Pearson chi-squared tests with Bonferroni correction and t-tests, as appropriate. A logistic regression model was also developed to evaluate risk factors for infection. Lastly, a prespecified analysis of the effect of infectious complications on patients with tMCS was completed.
Results: Of the 981 patients in the cohort, 354 (36%) developed a concomitant infection. Patients with infection had more hospital (15 vs. 34, p<0.01) and ICU days (8 vs. 21, p<0.01), and more days on MV (14 vs. 5, p<0.01). Patients with infection also had more days of tMCS support (3 vs. 9, p< 0.01). The use of tMCS (OR: 2.1, 95% CI 1.2 to 2.8) and SCAI staging (OR: 1.3, 95% CI: 1.1 to 1.4) were independent predictors of the presence of infection. When looking at tMCS use in the overall cohort, 342 (35%) patients required tMCS with 165 (48%) developing an infection. tMCS patients with an infection had prolonged tMCS support (19 vs. 11, p<0.01), days MV (16 vs. 7, p<0.01) and days in an ICU (29 vs. 12, p<0.01). There was also a four-fold increase in cumulative days of antibiotic therapy (45 vs. 11, p<0.01) in tMCS patients that had an infection.
Conclusion: Concomitant infection in cardiogenic shock significantly worsened the clinical outcomes, leading to an increase in resource utilization. The link between tMCS and infection highlights the importance of effective infection prevention in improving patient outcomes.