The association of early or late combined infection with clinical outcomes in cardiogenic shock patients

Aims Infections are common predisposing factors for mixed cardiogenic shock (CS) due to their contribution to systemic vasodilation. However, data on the prognosis of mixed CS complicated by infection remain limited. This study compared the clinical picture and outcomes of isolated CS and mixed CS, stratified by the timing of infection. Methods and results We analysed 878 adult CS patients admitted to a cardiac intensive care unit (CICU) between 2012 and 2020. Patients were classified as isolated CS (non-infected), early mixed CS (infection identified within 48 h of CICU admission), and late mixed CS (infection identified after 48 h of CICU admission). The primary outcome was in-hospital mortality. Of 878 patients, 591 (67.3%) had isolated CS, while 287 (32.7%) had mixed CS (early: 18.1%; late: 14.6%). Mixed CS patients experienced prolonged mechanical ventilation (isolated: 2.2 vs. early: 4.7 vs. late: 9.5 days; P < 0.001), and indwelling catheterization (2.0 vs. 7.0 vs. 25.2 days; P < 0.001). In late mixed CS patients, an increasing trend of nosocomial infection was observed with the increase of total catheterization day and CICU length of stay. In-hospital mortalities in both mixed CS groups were higher than in isolated CS (both P < 0.001), with no significant difference between early and late mixed CS. Survival rates also followed a similar pattern during the follow-up. Conclusion Mixed CS complicated by infection showed worse clinical outcomes than isolated CS, irrespective of the infection timing. Further research is needed to develop targeted treatment strategies tailored to this condition.