{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T07:24:43Z","timestamp":1793258683840,"version":"4.5.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Patients presenting with cardiogenic shock (CS) are at risk of developing mixed shock (MS), characterized by distributive-inflammatory phenotype. However, no objective definition exists for this clinical entity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We assessed the frequency, predictors, and prognostic relevance of MS complicating CS, based on a newly proposed objective definition. MS complicating CS was defined as an objective shock state secondary to both an ongoing cardiogenic cause and a distributive-inflammatory phenotype arising at least 12 hours after the initial CS diagnosis, as substantiated by predefined longitudinal changes in hemodynamics, clinical, and laboratory parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 213 consecutive patients admitted at 2 cardiac intensive care units with CS, 13 with inflammatory-distributive features at initial presentation were excluded, leading to a cohort of 200 patients hospitalized with pure CS (67\u00b113 years, 96% Society of Cardiovascular Angiography and Interventions CS stage class C or higher). MS complicating CS occurred in 24.5% after 120 (29\u2013216) hours from CS diagnosis. Lower systolic arterial pressure (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.043), hepatic injury (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.049), and suspected\/definite infection (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.013) at CS diagnosis were independent predictors of MS development. In-hospital mortality (53.1% versus 27.8%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002) and hospital stay (21 [13\u201348] versus 17 [9\u201327] days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.018) were higher in the MS cohort. At logistic multivariable analysis, MS diagnosis (odds ratio [OR], 3.00 [95% CI, 1.39\u20136.63];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>adj<\/jats:sub>\n                      =0.006), age (OR, 1.06 [95% CI, 1.03\u20131.10] years;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>adj<\/jats:sub>\n                      &lt;0.001), admission systolic arterial pressure &lt;100 mm\u2005Hg (OR, 2.41 [95% CI, 1.19\u20134.98];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>adj<\/jats:sub>\n                      =0.016), and admission serum creatinine (OR, 1.61 [95% CI, 1.19\u20132.26];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>adj<\/jats:sub>\n                      =0.003) conferred higher odds of in-hospital death, while early temporary mechanical circulatory support was associated with lower in-hospital death (OR, 0.36 [95% CI, 0.17\u20130.75];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>adj<\/jats:sub>\n                      =0.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>MS complicating CS, objectively defined leveraging on longitudinal changes in distributive and inflammatory features, occurs in one-fourth of patients with CS, is predicted by markers of CS severity and inflammation at CS diagnosis, and portends higher hospital mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.123.011404","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T05:00:53Z","timestamp":1720501253000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Mixed Shock Complicating Cardiogenic Shock: Frequency, Predictors, and Clinical Outcomes"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5986-049X","authenticated-orcid":true,"given":"Luca","family":"Baldetti","sequence":"first","affiliation":[{"name":"Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8011-6844","authenticated-orcid":true,"given":"Guglielmo","family":"Gallone","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, Turin, Italy (G.G., E.R., L.N., G.M., G.D.L., P.B., F.A., G.M.D.F., S.F.)."},{"name":"Department of Medical Sciences, University of Turin, Italy (G.G., L.P., E.R., L.N., G.M., G.M.D.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Filiberti","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Pescarmona","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, Italy (G.G., L.P., E.R., L.N., G.M., G.M.D.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1373-4348","authenticated-orcid":true,"given":"Andrea","family":"Cesari","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2348-826X","authenticated-orcid":true,"given":"Vincenzo","family":"Rizza","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Roagna","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, Turin, Italy (G.G., E.R., L.N., G.M., G.D.L., P.B., F.A., G.M.D.F., S.F.)."},{"name":"Department of Medical Sciences, University of Turin, Italy (G.G., L.P., E.R., L.N., G.M., G.M.D.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3121-0753","authenticated-orcid":true,"given":"Davide","family":"Gurrieri","sequence":"additional","affiliation":[{"name":"Mathematics Department, Polytechnic University of Milan, Italy (D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Peveri","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4048-1096","authenticated-orcid":true,"given":"Lorenzo","family":"Nocera","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, Turin, Italy (G.G., E.R., L.N., G.M., G.D.L., P.B., F.A., G.M.D.F., S.F.)."},{"name":"Department of Medical Sciences, University of Turin, Italy (G.G., L.P., E.R., L.N., G.M., G.M.D.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2600-4301","authenticated-orcid":true,"given":"Lorenzo","family":"Cianfanelli","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Marcelli","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., G.F., A.C., V.R., B.P., L.C., M.G., V.P., S.S., F.C., S.A., A.M.S.)."},{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, Turin, Italy (G.G., E.R., L.N., G.M., G.D.L., P.B., F.A., G.M.D.F., S.F.)."},{"name":"Department of Medical Sciences, University of Turin, Italy (G.G., L.P., E.R., L.N., G.M., G.M.D.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"De Lio","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 della Salute e della Scienza Hospital, Turin, Italy (G.G., E.R., L.N., G.M., G.D.L., P.B., F.A., G.M.D.F., 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