Kidney and liver dysfunction in cardiogenic shock.

PURPOSE OF REVIEW: Organ dysfunction is a key feature of cardiogenic shock. Active revascularization and contemporary management in intensive care has improved prognosis in cardiogenic shock, but mortality is still unacceptably high. This review will discuss the prevalence, manifestation, management and clinical impact of kidney and liver dysfunction in cardiogenic shock.

RECENT FINDINGS: Patients with cardiogenic shock more frequently have several comorbidities that make them at risk of developing multiorgan failure, including renal and liver dysfunction. Kidney and liver injury and dysfunction will markedly increase mortality of patients with cardiogenic shock. Management requires active monitoring of organ function and knowledge of criteria for detection and classification of organ injury. The SOFA score for prediction of mortality in the critically ill incorporates organ injury and can be used also in cardiogenic shock, but risk prediction models specific for cardiogenic shock exist. Biomarkers reflecting different pathways activated in cardiogenic shock correlate with severity of organ dysfunction and may improve risk prediction in cardiogenic shock. Preliminary data suggest that they can even be future treatment targets.

SUMMARY: Monitoring renal and hepatic function and identifying injury and dysfunction of these organs is essential for the management and mortality risk assessment of patients in cardiogenic shock.