Acute and Critical Care

Original Articles

Cardiology
Prognostic validation and risk stratification of the Society for Cardiovascular Angiography and Interventions cardiogenic shock classification in a large, real-world intensive care unit cohort in South Korea: Haechan Cho, Jeehoon Kang, Minju Han, Huijin Lee, Hyun-Jai Cho; Acute Crit Care. 2026;41(1):117-125. Published online February 27, 2026; DOI: https://doi.org/10.4266/acc.004500

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Abstract PDF Supplementary Material: Background
Cardiogenic shock (CS) imparts a high mortality rate, yet a standardized classification of its severity remains lacking. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a five-stage classification scheme to improve risk stratification, but its prognostic value in real-world intensive care unit (ICU) populations is still insufficiently validated.
Methods
We retrospectively analyzed 3,074 adults admitted to the medical and cardiovascular ICUs under the Division of Cardiology at a tertiary academic medical center between 2010 and 2019. SCAI shock stages (A–E) were assigned at admission using data on hemodynamic instability, hypoperfusion, clinical deterioration, and refractory shock. The primary outcome was ICU mortality.
Results
ICU mortality rates across stages A–E were 0.5%, 4.3%, 5.2%, 18.8%, and 53.2% (P<0.001). Compared to stage A, higher stages were independently associated with mortality (adjusted odds ratio, 3.93–31.58). The discriminatory ability of the SCAI CS classification was moderate (area under the receiver operating characteristic curve [AUROC], 0.787) but improved markedly with the addition of Acute Physiology and Chronic Health Evaluation II scores (AUROC, 0.929).
Conclusions
The SCAI CS classification offers clear, incremental risk stratification of ICU mortality. When combined with global severity scores, it provides superior prognostic accuracy, supporting its routine use in the management and study of CS.

Pediatric
Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children: Soo Yeon Kim, Byuhree Kim, Sun Ha Choi, Jong Deok Kim, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim; Acute Crit Care. 2018;33(4):222-229. Published online November 29, 2018; DOI: https://doi.org/10.4266/acc.2018.00136

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Background
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS.
Methods
Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
Results
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Conclusions
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

Citations

Citations to this article as recorded by

A single‐center PICU present status survey of pediatric sepsis‐related acute respiratory distress syndrome
Liang Zhou, Shaojun Li, Tian Tang, Xiu Yuan, Liping Tan
Pediatric Pulmonology.2022; 57(9): 2003. CrossRef
Comparison of Prognostic Factors Between Direct and Indirect Pediatric ARDS
Da Hyun Kim, Eun Ju Ha, Seong Jong Park, Won Kyoung Jhang
Respiratory Care.2020; 65(12): 1823. CrossRef

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