BACKGROUND: Altered mental status is among the signs of hypoperfusion in cardiogenic shock, the most severe form of acute heart failure. The aim of this study was to investigate the prevalence of altered mental status, to identify factors associating with it, and to assess the prognostic significance of altered mental status in cardiogenic shock. METHODS: Mental status was assessed at presentation of shock in 215 adult cardiogenic shock patients in a multinational, prospective, observational study. Clinical picture, biochemical variables, and short-term mortality were compared between patients presenting with altered and normal mental status. RESULTS: Altered mental status was detected in 147 (68%) patients, whereas 68 (32%) patients had normal mental status. Patients with altered mental status were older (68 vs. 64 years, p=0.04) and more likely to have an acute coronary syndrome than those with normal mental status (85% vs. 74%, p=0.04). Altered mental status was associated with lower systolic blood pressure (76 vs. 80 mmHg, p=0.03) and lower arterial pH (7.27 vs. 7.35, p<0.001) as well as higher levels of blood lactate (3.4 vs. 2.3 mmol/l, p<0.001) and blood glucose (11.4 vs. 9.0 mmol/l, p=0.01). Low arterial pH (adjusted odds ratio 1.6 (1.1-2.2), p=0.02) was the only factor independently associated with altered mental status. Ninety-day mortality was significantly higher (51% vs. 22%, p<0.001) among patients with altered mental status. CONCLUSIONS: Altered mental status is a common clinical sign of systemic hypoperfusion in cardiogenic shock and is associated with poor outcome. It is also associated with several biochemical findings that reflect inadequate tissue perfusion, of which low arterial pH is independently associated with altered mental status.

Cardiology University of Helsinki Heart and Lung Centre Helsinki University Hospital Finland

CINTESIS Centre for Health Technology and Services Research Department of Cardiology Faculty of Medicine University of Porto São João Medical Centre Portugal

Department of Medical Sciences and Translational Medicine University of Rome Sapienza Emergency Department Sant' Andrea Hospital Italy

Division of Cardiology Department of Medical and Surgical Specialties Radiological Sciences and Public Health University and Civil Hospital of Brescia Italy

Division of Emergency Medicine University of Helsinki Helsinki University Hospital Finland

Heart Failure Clinic Attikon University Hospital Athens Greece

INSERM U942 Hopital Lariboisiere APHP and University Paris Diderot France

Intensive Cardiac Care Unit Cardiology Department Hospital de la Santa Creu i Sant Pau Biomedical Research Institute IIB Sant Pau Universitat de Barcelona Spain

Intensive Cardiac Therapy Clinic Institute of Cardiology Warsaw Poland

Internal Cardiology Department University Hospital Brno and Masaryk University Brno Czech Republic

Rigshospitalet Copenhagen University Hospital Division of Heart Failure Pulmonary Hypertension and Heart Transplantation Denmark

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