Mixed cardiogenic-vasoplegic shock (M-CS) represents a distinct and severe phenotype of cardiogenic shock characterized by concomitant myocardial dysfunction and inappropriate systemic vasodilation. Despite its clinical relevance, the epidemiology, management, and outcomes of M-CS remain poorly defined. This retrospective, multicenter, observational registry aims to evaluate the clinical outcomes and prognostic factors associated with mixed cardiogenic-vasoplegic shock. The study will analyze clinical, biological, and invasive hemodynamic data routinely collected during patient management for M-CS. All included patients will have been admitted for cardiogenic shock, with or without vasoplegia, defined by low cardiac output and, when present, decreased systemic vascular resistance despite adequate filling pressures requiring vasopressor support. The primary objective is to describe mortality and organ failure rates, while secondary analyses will identify determinants of adverse outcomes and potential phenotypic subgroups. The PROMIX registry will be conducted across three French university hospitals (CHU Amiens-Picardie, CHU Dijon-Bourgogne, and CHU Rouen-Normandie). This study is non-interventional, involving only data obtained as part of routine critical care, and will provide the first multicenter overview of this complex and underrecognized form of cardiogenic shock.
Study Type
OBSERVATIONAL
Enrollment
2,500
CHU Amiens Picardie
Amiens, Somme, France
RECRUITINGAll-cause mortality at 90 days
documented death occurring within 90 days following ICU admission
Time frame: 90 days
Clinical characteristics and management trajectories
This outcome is descriptive in nature and aims to characterize the study population. Baseline variables (e.g., age, sex, cardiovascular history, comorbidities, and etiology of shock) will be reported separately using appropriate units for each variable (e.g., years, proportions, or categories), without aggregation into a single summary measure.
Time frame: 90 days
Phenotyping Cardiogenic Shock by Clustering
Identification of subgroups using unsupervised classification methods (clustering) and comparison of 90-day mortality rates.
Time frame: 90 days
Evolution of the SCAI Classification
Dynamic Evolution of the SCAI Classification (A to E) during the ICU stay. Each stage of classification is recording each day and during all ICU stay.
Time frame: 90 days
Evolution of Arterial Pressure
To assess the dynamic evolution of systolic, diastolic, and mean blood pressure (in mmHg) from Day 0 (D0) to Day 7 (D7)
Time frame: 7 days
Evolution of Norepinephrine Equivalent (NEE) Requirement
NEE (expressed in µg/kg/min) will be calculated at predefined time points: D0, D1, D3, D5, and D7, using standardized conversion factors to express all vasopressor doses as norepinephrine equivalents.
Time frame: 7 days
Evolution of Vasopressor Requirement
To assess the dynamic evolution of vasopressor and inotropic support quantified using the Vasopressor-Inotropic Score (VIS). VIS is calculated as a composite score based on standardized doses of vasopressors and inotropes, with higher scores indicating greater vasopressor and inotropic support (worse hemodynamic severity). VIS values will be assessed at predefined time points Day 0, Day 1, Day 3, Day 5, and Day 7 after shock onset.
Time frame: 7 days
Clinical outcomes
Use of renal replacement therapy and mechanical circulatory support (VA-ECMO, Impella, intra-aortic balloon pump).
Time frame: 90 days
ICU length of stay
Duration of ICU length of stay (days) since the ICU admission
Time frame: 90 days
Hospital lenght of stay
Duration of the Hospital lenght of stay (days) since the hospital admission and home discharge.
Time frame: 90 days
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