Predictors and Prognostic Impact of Early Acute Kidney Injury in Cardiogenic Shock: Results from a Monocentric, Prospective Registry.

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiorenal Medicine Pub Date : 2024-01-01 Epub Date: 2024-02-05 DOI:10.1159/000533975

Tobias Schupp, Michael Behnes, Jonas Rusnak, Kathrin Weidner, Marinela Ruka, Jonas Dudda, Alexander Schmitt, Jan Forner, Sascha Egner-Walter, Niklas Ayasse, Thomas Bertsch, Maximilian Kittel, Ibrahim Akin

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引用次数: 0

Abstract

Introduction: The presence of acute kidney injury (AKI) was shown to increase the risk of mortality following acute myocardial infarction; however, data regarding the prognostic impact of early AKI in patients with concomitant cardiogenic shock (CS) is limited. The study investigates predictors and the prognostic impact of AKI in patients with CS.

Methods: Consecutive patients with CS from 2019 to 2021 were included at one institution. Laboratory values were retrieved from day of disease onset (day 1) and days 2, 3, 4, and 8 thereafter. Predictors for AKI (defined as an increase of plasma creatinine >50% within 48 h referring to pre-admission or baseline creatinine on day 1 and/or the need for continuous veno-venous hemodiafiltration [CVVHDF]) and the prognostic impact of early AKI with regard to 30-day all-cause mortality were assessed. Statistical analyses included t test, Spearman's correlation, C-statistics, Kaplan-Meier, and Cox proportional regression analyses.

Results: A total of 219 CS patients were included with an incidence of early CS-related AKI of 52%. With an area under the curve of up to 0.689 (p = 0.001), creatine discriminated 30-day mortality in CS. Increasing lactate levels (OR = 1.194; 95% CI: 1.083-1.316; p = 0.001; per increase of 1 mmol/L) was associated with the occurrence of AKI. The presence of AKI was associated with an increased risk of 30-day all-cause mortality (63% vs. 36%; HR = 2.138; 95% CI: 1.441-3.171; p = 0.001), even after multivariable adjustment (HR = 1.861; 95% CI: 1.207-2.869; p = 0.005). Finally, highest risk of all-cause mortality was observed in patients with AKI requiring CVVHDF (75% vs. 44%; log rank p = 0.001; HR = 2.211; 95% CI: 1.315-3.718; p = 0.003).

Conclusion: Early AKI affects more than half of patients with CS and is independently associated with 30-day all-cause mortality in CS, with highest risk of death among patients with AKI requiring CVVHDF.

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心源性休克早期急性肾损伤的预测因素和预后影响：单中心、前瞻性登记的结果。

导言：研究表明，急性肾损伤（AKI）会增加急性心肌梗死（AMI）后的死亡风险，然而，有关急性肾损伤对合并心源性休克（CS）患者预后影响的数据却很有限。该研究调查了CS患者AKI的预测因素和预后影响：方法：纳入一家医院2019年至2021年的连续CS患者。从发病当天（第1天）及其后的第2、3、4和8天采集实验室值。评估了AKI（定义为与入院前或第1天的基线肌酐相比，48小时内血浆肌酐升高>50%，和/或需要持续静脉血液滤过（CVVHDF））的预测因素以及AKI对30天全因死亡率的预后影响。统计分析包括单变量 t 检验、Spearman 相关性、C 统计、Kaplan-Meier 和 Cox 比例回归分析。肌酸的曲线下面积（AUC）高达 0.689（P =0.001），可区分 CS 患者的 30 天死亡率。乳酸水平的升高（OR = 1.194；95% CI 1.083 - 1.316；p = 0.001；每升高 1 毫摩尔/升）与发生 AKI 相关。即使经过多变量调整（HR = 1.861; 95% CI 1.207 - 2.869; p = 0.005），出现 AKI 仍与 30 天全因死亡率风险增加有关（63% 对 36%；HR = 2.138; 95% CI 1.441 - 3.171 p = 0.001）。最后，需要进行 CVVHDF 的 AKI 患者全因死亡风险最高（75% 对 44%；对数秩 p = 0.001；HR = 2.211；95% CI 1.315 - 3.718；p = 0.003）：结论：半数以上的 CS 患者患有 AKI，AKI 与 CS 患者 30 天的全因死亡率密切相关，需要 CVVHDF 的 AKI 患者死亡风险最高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiorenal Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-UROLOGY & NEPHROLOGY

CiteScore

5.40

自引率

2.60%

发文量

审稿时长

>12 weeks

期刊介绍： The journal ''Cardiorenal Medicine'' explores the mechanisms by which obesity and other metabolic abnormalities promote the pathogenesis and progression of heart and kidney disease (cardiorenal metabolic syndrome). It provides an interdisciplinary platform for the advancement of research and clinical practice, focussing on translational issues.