Relation of Serum Creatinine Twitches and Outcomes among STEMI Patients.

IF 2.3 4区医学 Q2 PERIPHERAL VASCULAR DISEASE

Kidney & blood pressure research Pub Date : 2025-03-28 DOI:10.1159/000545523

Shir Frydman, Ophir Freund, Lior Zornitzki, Nevo Barel, Shmuel Banai, Yacov Shacham

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引用次数: 0

Abstract

Background: Acute kidney injury (AKI) is notoriously associated with adverse outcomes and mortality in patients with acute coronary syndrome. However, using the general cutoff of 0.3 mg/dL increase from baseline for AKI definition and neglecting smaller changes could result in late diagnosis and impaired prognostication. We aimed to assess the prognostic utility of minor creatinine changes ("twitches") in a large cohort of ST-segment-elevation myocardial infraction (STEMI) patients and determine an optimal cutoff value for future use.

Methods: This retrospective analysis of a prospective database included 2933 consecutive patients admitted with STEMI between 2008-2022 to the cardiac intensive care unit of a large tertiary medical center. Renal function was assessed upon admission and at-least once daily thereafter. Creatinine twitches were defined as a change from baseline to peak creatinine level of between 0.1 to 0.3 mg/dl. 30-day and 1-year mortality were the main outcomes.

Results: From the study cohort (mean age 62 ±13, 19% female, 16% with prior MI), 551 (19%) subjects presented creatinine twitches and 254 (9%) developed AKI. Compared to subjects with stable creatinine, those with creatinine twitches had higher rates of 30-day (1% vs. 2.5%, p<0.001) and 1-year (1.6% vs. 4.4%, p<0.001) mortality. In cox multivariate analysis, creatinine twitches had a higher hazard for 1-year mortality (HR 1.87, 95% CI 1.1-3.2) and only a trend for 30-day mortality (HR 1.52, 95% CI 0.96-2.96). Creatinine rise had an area under the curve of 0.780 (95% CI 0.73-0.83) for 1-year mortality prediction, and 0.12 mg/dl was the optimal cutoff for prediction, with a sensitivity of 71%, specificity of 79%. In sub-group multivariate analysis, only twitches that did not resolve during hospitalization had higher hazard for mortality (HR 3.42, 95% CI 1.65-7.05).

Conclusion: Serum creatinine twitches are common among STEMI patients and correlate with elevated 30 days and 1-year mortality. These seemingly minor changes should prompt renal protective strategies for early detection and treatment.

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STEMI患者血清肌酐抽搐与预后的关系。

背景：众所周知，急性肾损伤（AKI）与急性冠脉综合征患者的不良结局和死亡率相关。然而，使用比基线增加0.3 mg/dL的一般临界值来定义AKI，而忽略较小的变化可能导致晚期诊断和预后受损。我们的目的是在st段抬高型心肌梗死（STEMI）患者的大队列中评估轻微肌酐变化（“抽搐”）的预后效用，并确定未来使用的最佳临界值。方法：回顾性分析前瞻性数据库，包括2008-2022年间在一家大型三级医疗中心心脏重症监护室连续收治的2933例STEMI患者。入院时评估肾功能，此后每天至少评估一次。肌酐抽搐被定义为从基线到峰值肌酐水平在0.1至0.3 mg/dl之间的变化。30天死亡率和1年死亡率是主要结局。结果：在研究队列中（平均年龄62±13岁，19%为女性，16%为既往心肌梗死），551（19%）名受试者出现肌酐抽搐，254（9%）名受试者出现AKI。与肌酸酐稳定的受试者相比，肌酸酐抽搐患者30天的发生率更高（1% vs. 2.5%）。结论：血清肌酸酐抽搐在STEMI患者中很常见，并与30天和1年死亡率升高相关。这些看似微小的变化应该促进肾脏保护策略的早期发现和治疗。

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

Kidney & blood pressure research 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal comprises both clinical and basic studies at the interface of nephrology, hypertension and cardiovascular research. The topics to be covered include the structural organization and biochemistry of the normal and diseased kidney, the molecular biology of transporters, the physiology and pathophysiology of glomerular filtration and tubular transport, endothelial and vascular smooth muscle cell function and blood pressure control, as well as water, electrolyte and mineral metabolism. Also discussed are the (patho)physiology and (patho) biochemistry of renal hormones, the molecular biology, genetics and clinical course of renal disease and hypertension, the renal elimination, action and clinical use of drugs, as well as dialysis and transplantation. Featuring peer-reviewed original papers, editorials translating basic science into patient-oriented research and disease, in depth reviews, and regular special topic sections, ''Kidney & Blood Pressure Research'' is an important source of information for researchers in nephrology and cardiovascular medicine.