Abstract 4370159: In-Hospital Outcomes of Acute Noncardiac Organ Failure among Non-Acute Myocardial Infarction Cardiogenic Shock: A Nationwide Cohort Analysis

Introduction: Noncardiac organ failure is a frequent complication in non–acute myocardial infarction (non-AMI) cardiogenic shock (CS), yet its impact on in-hospital outcomes remains understudied. Methods: We analyzed data from the Nationwide Inpatient Sample (2016–2021) to identify hospitalizations for non-AMI CS among patients ≥18 years. We assessed the incidence of acute kidney injury (AKI), acute neurological failure, acute hematologic failure, acute respiratory failure, and acute liver failure during hospitalization. Patients were stratified into three groups: no organ failure, single-organ failure, and multi-organ failure (≥2 systems). Primary outcomes included in-hospital mortality (IHM) and total hospitalization costs. Univariable and multivariable survey weighted logistic regression was used to evaluate the association between organ failure and IHM. Results: We identified 258,022 adult non-AMI CS hospitalizations. The median age was 67 years (IQR: 56–76), 63% were male, and 64% had chronic heart failure. AKI (62.0%) was the most common organ failure, followed by acute respiratory failure (56.6%) (Figure 1.A). Overall, 53.8% developed multi-organ failure, 31.8% had single-organ failure, and 14.4% had no organ failure. The overall IHM rate was 28.9%. Neurological failure had the highest IHM (71.9%), followed by liver failure (44.0%) (Figure 1.B). IHM was significantly higher in patients with multi-organ failure (37.9%) compared to single-organ (20.6%) and no organ failure (13.8%) (p < 0.001) (Figure 1.C). After adjustment, both multi-organ failure (aOR 1.17; 95% CI 1.16–1.18) and single-organ failure (aOR 1.06; 95% CI 1.06–1.07) were associated with increased odds of IHM (p < 0.001). The median hospitalization cost was $35,906 (IQR: $17,532–$70,706), and was significantly higher in those with multi-organ ($40,952; IQR: 19984-83118) and single-organ failure ($32,769; IQR: 16073-62567) (p < 0.001) (Table 1). Conclusion: Noncardiac organ failure is common in non-AMI CS hospitalizations, with AKI being the most frequent and over half of patients experiencing multi-organ failure. Neurological failure was associated with the highest mortality. Both single and multi-organ failure were independently linked to increased IHM and higher healthcare costs, emphasizing the need for early recognition and targeted management strategies in this population.