In-hospital outcomes of percutaneous left ventricular assist device recipients in cardiogenic shock hospitalizations with chronic kidney disease: A nationwide analysis

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2025-01-17 DOI:10.1016/j.cpcardiol.2025.102993

Akhil Jain MD , Karnav Modi MBBS , Ankit Vyas MD , Maharshi Raval MD , Argishty Mirzakhanian , Parth R Nayak MD , Rupak Desai MBBS , Venkat Subramaniam MD , Kiran Garikapati MD , Rajkumar Doshi MD , Sourbha S. Dani MD , William Bennett MD , Carl J. Lavie MD , Jose Tafur Soto MD

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引用次数: 0

Abstract

Background

There is a lack of data on the role of chronic kidney disease (CKD) in patients who received percutaneous left ventricular assist devices (pLVAD) as mechanical circulatory support (MCS) as an adjunct treatment for cardiogenic shock (CS) management.

Methods

Using National Inpatient Sample (2016-19), we extracted CS patients receiving pLVAD and divided them into CKD and non-CKD cohorts. Multivariate regression analysis was used for adjusted odds ratios for outcomes before and after entropy balancing (EB) and predictive margins for the probability of all-cause in-hospital mortality (ACM). ACM was also compared between CS patients who did not receive MCS.

Results

In our study, 29,515 patients received pLVAD as the only MCS device in CS, and the prevalence of CKD amongst them was 9.7 %. After EB, ACM did not differ in CS with and without CKD (aOR 1.008, p = 0.953). Higher adjusted incidence rate ratios (IRR) were noted for length of stay (LOS) (aOR 1.68, p < 0.001) and hospitalization cost (aOR 1.365, p = 0.001) in CS with CKD. Mean LOS and hospitalization cost was significantly higher in CKD cohort before and after EB (post-EB: 17.4 days vs. 10.3 days, p < 0.001 and USD 652097 vs. 482359, p = 0.001, respectively). ACM was significantly higher in CS patients who did not receive any MCS if they had CKD (aOR 1.26, p < 0.001).

Conclusion

CKD patients receiving pLVAD for CS had no difference in ACM but had higher resource utilization than those without CKD. pLVAD use was associated with a lower ACM in CKD patients when compared to patients who did not receive any MCS.

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慢性肾病心源性休克住院患者经皮左心室辅助装置接受者的住院结果：一项全国性分析

背景：目前缺乏关于慢性肾脏疾病（CKD）在接受经皮左心室辅助装置（pLVAD）作为机械循环支持（MCS）作为心源性休克（CS）管理辅助治疗的患者中的作用的数据。方法：选取2016-19年全国住院患者样本，抽取接受pLVAD的CS患者，将其分为CKD和非CKD两组。多变量回归分析用于熵平衡（EB）前后结果的调整优势比和全因住院死亡率（ACM）概率的预测边际。还比较了未接受MCS的CS患者之间的ACM。结果：在我们的研究中，29,515例患者接受pLVAD作为CS中唯一的MCS装置，其中CKD患病率为9.7%。EB后，伴有和不伴有CKD的CS的ACM无差异（aOR 1.008, p=0.953）。住院时间（LOS）的调整发生率比（IRR）更高（aOR为1.68,p）。结论：CKD患者因CS接受pLVAD治疗的ACM无差异，但资源利用率高于非CKD患者。与未接受任何MCS的患者相比，使用pLVAD与CKD患者较低的ACM相关。

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

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.