Heart failure subphenotypes based on mean arterial pressure trajectory identify patients at increased risk of acute kidney injury.

IF 3 3区医学 Q1 UROLOGY & NEPHROLOGY

Renal Failure Pub Date : 2025-12-01 Epub Date: 2025-01-19 DOI:10.1080/0886022X.2025.2452205

Xiya Wang, Wenqing Ji, Shuxing Wei, Zhong Dai, Xinzhen Gao, Xue Mei, Shubin Guo

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Abstract

Background: Acute kidney injury (AKI) is a common complication in heart failure (HF) patients. Patients with heart failure who experience renal injury tend to have a poor prognosis. The objective of this study is to examine the correlation between the occurrence of AKI in heart failure patients and different mean arterial pressure (MAP) trajectories, with the goal of improving early identification and intervention for AKI.

Methods: A retrospective study was conducted on patients with heart failure using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV). We utilized the group-based trajectory modeling (GBTM) method to classify the 24-hour MAP change trajectories in heart failure patients. The occurrence of AKI within the first 7 days of intensive care unit (ICU) admission was considered the outcome. The impact of MAP trajectories on AKI occurrence in heart failure patients was analyzed using Cox proportional hazards models, competing risk models, and doubly robust estimation methods.

Results: A cohort of 8,502 HF patients was analyzed, with their 24-hour MAP trajectories categorized into five groups: Low MAP group (Class 1), Medium MAP group (Class 2), Low-medium MAP group (Class 3), High-to-low MAP group (Class 4), and High MAP group (Class 5). The results from the doubly robust analysis revealed that Class 4 exhibited a significantly increased AKI risk than Class 3 (HR 1.284, 95% CI 1.085-1.521, p = 0.003; HR 1.271, 95% CI 1.074-1.505, p = 0.005). Conversely, the risks of Class 2 were significantly lower than those of Class 3 (HR 0.846, 95% CI 0.745-0.960, p = 0.009; HR 0.879, 95% CI 0.774-0.998, p = 0.047).

Conclusions: The 24-hour MAP trajectory in HF patients influences the risk of AKI. A rapid decrease in MAP (Class 4) is associated with a higher AKI risk, while maintaining MAP at a moderate level (Class 2) significantly reduces this risk. Therefore, closely monitoring MAP changes is crucial for preventing AKI in HF.

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基于平均动脉压轨迹的心力衰竭亚表型识别急性肾损伤风险增加的患者。

背景：急性肾损伤（AKI）是心力衰竭（HF）患者的常见并发症。心衰患者肾损伤往往预后较差。本研究的目的是探讨心衰患者AKI发生与不同平均动脉压（MAP）轨迹的相关性，以提高AKI的早期识别和干预。方法：利用重症监护医学信息市场（MIMIC-IV）的数据对心力衰竭患者进行回顾性研究。采用基于组的轨迹建模（GBTM）方法对心力衰竭患者24小时MAP变化轨迹进行分类。重症监护病房（ICU）入院前7天内AKI的发生被认为是结局。使用Cox比例风险模型、竞争风险模型和双鲁棒估计方法分析MAP轨迹对心衰患者AKI发生的影响。结果：对8502例HF患者进行队列分析，将其24小时MAP轨迹分为5组：低MAP组（1类）、中MAP组（2类）、中低MAP组（3类）、高低MAP组（4类）和高MAP组（5类）。双稳健分析结果显示，4类患者AKI风险显著高于3类患者(HR 1.284, 95% CI 1.085-1.521, p = 0.003；HR 1.271, 95% CI 1.074 ~ 1.505, p = 0.005)。相反，2级患者的风险显著低于3级患者(HR 0.846, 95% CI 0.745-0.960, p = 0.009；HR 0.879, 95% CI 0.774-0.998, p = 0.047)。结论：HF患者24小时MAP轨迹影响AKI的发生风险。MAP（4级）快速降低与AKI风险升高相关，而将MAP维持在中等水平（2级）可显著降低这种风险。因此，密切监测MAP变化对于预防心衰患者AKI至关重要。

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

Renal Failure 医学-泌尿学与肾脏学

CiteScore

3.90

自引率

13.30%

发文量

374

审稿时长

1 months

期刊介绍： Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.