Cardiogenic shock (CS) and sepsis represent severe hemodynamic states, frequently associated, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock.

To describe outcomes of combined sepsis and cardiogenic shock.

FRENSHOCK was a prospective registry including 772 CS patients from 49 centers. Primary endpoint was one-month all-cause mortality. Secondary endpoints included heart transplantation (HTx), ventricular assistance device (VAD) and all-cause mortality at 1 year.

Among 772 CS included, 92 were sepsis-triggered (11.9%) (Figure 1), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Septic patients required broader use of dobutamine (91 vs. 81.2%, P=0.04), norepinephrine (72.5 vs. 50.8%, P<0.01), renal replacement therapy (29.7 vs. 14%, P<0.01), non-invasive (36.3 vs. 24.4%, P=0.02) and invasive (52.7 vs. 35.9%, P<0.01) ventilation. Sepsis-triggered CS resulted in a higher 1-month (41.3 vs. 24%, aHR 1.94 [1.36–2.76], P<0.01) and 1-year (62 vs. 42.9%, aHR 1.75 [1.32–2.33], P<0.01) all-cause mortality. No significant difference was found at 1 year for HTx or VAD (8.7 vs. 10.3%, aOR 0.72 [0.32–1.64], P=0.43). Within sepsis-triggered CS, neither the presence of a pre-existing cardiomyopathy nor the co-occurrence of other CS triggers demonstrated any additional impact on mortality.

The association between sepsis and CS represents a common high-risk scenario, leading to higher short- and long-term mortality regardless of the association with other CS triggers, or the presence of pre-existing cardiomyopathy.