Worsening Renal Function Is Common and Associated With Higher Mortality in Cardiogenic Shock: A Cardiogenic Shock Working Group Report.

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure Pub Date : 2025-04-01 DOI:10.1016/j.cardfail.2025.03.012

Rachna Kataria, Shashank S Sinha, Song Li, Qiuyue Kong, Manreet Kanwar, Jaime Hernandez-Montfort, A Reshad Garan, Jacob Abraham, Elric Zweck, Van-Khue Ton, David M Dudzinski, Anthony Faugno, Maryjane Farr, Esther Vorovich, Shelley Hall, Maya Guglin, Mohit Pahuja, Kevin John, Ajar Kochar, Vanessa Blumer, Saraschandra Vallabhajosyula, Sandeep Nathan, Neil M Harwani, Gavin W Hickey, Andrew D Schwartzman, Wissam Khalife, Claudius Mahr, Ju H Kim, Arvind Bhimaraj, Paavni Sangal, Karol D Walec, Peter Zazzali, Justin Fried, Daniel Burkhoff, Navin K Kapur

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引用次数: 0

Abstract

Background: Outcomes associated with worsening renal function (WRF) in cardiogenic shock (CS) remain poorly understood.

Objectives: To study the incidence of WRF in heart failure-CS (HF-CS) and acute myocardial infarction CS (AMI-CS), examine its association with in-hospital mortality (IHM), define the trajectory of renal function in CS, and identify independent predictors of WRF in HF-CS versus AMI-CS.

Methods: Patients in the Cardiogenic Shock Working Group registry (CSWG) from 2021-2024 were analyzed; those with baseline end-stage renal disease were excluded. WRF was defined as an increase in creatinine ≥0.3 mg/dl, a decrease in eGFR >25%, or initiation of renal replacement therapy (RRT) within 72 hours of CS diagnosis.

Results: Of 6269 CS patients, 35% developed WRF, including 32% of HF-CS and 41% of AMI-CS patients. Patients who developed WRF were more likely to be transferred from other hospitals (63% vs 50%, p<0.001). Baseline right atrial pressure (RAP) was higher in both HF-CS (15 mmHg vs 12 mmHg, p<0.001) and AMI-CS (13 mmHg vs 11 mmHg, p=0.02) patients with WRF compared to patients without WRF. Incidence of WRF was higher among patients exposed to both tMCS and vasoactive agents as compared to vasoactive drugs alone (46% vs. 29%, p<0.001). Overall rate of RRT initiation was 20% throughout admission with higher rates in patients with acute on chronic versus de novo HF-CS and in patients with STEMI-CS versus NSTEMI-CS in the first 24 hours. IHM was higher in patients with WRF (41% vs 21%, p<0.001). In patients with WRF, median eGFR declined steadily throughout the first 72 hours after CS diagnosis. Key independent predictors of WRF included RAP, lactate, transfer status, in patients with HF-CS and CKD, lactate and transfer status in patients with AMI-CS.

Conclusion: WRF is common and deleterious in both HF- and AMI-CS. Given the early association with worse outcomes, WRF may not only be prognostic but also represent a potential therapeutic target in future CS studies.

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心源性休克工作小组报告：肾功能恶化是心源性休克患者的常见病，并与较高的死亡率有关。

背景：心源性休克（CS）中与肾功能恶化（WRF）相关的结局仍然知之甚少。目的：研究心力衰竭-CS （HF-CS）和急性心肌梗死CS （AMI-CS）中WRF的发生率，研究其与住院死亡率（IHM）的关系，确定CS中肾功能的发展轨迹，并确定HF-CS与AMI-CS中WRF的独立预测因子。方法：对心源性休克工作组（CSWG） 2021-2024年登记的患者进行分析；排除基线终末期肾病患者。WRF被定义为肌酐升高≥0.3 mg/dl， eGFR下降25%，或在CS诊断后72小时内开始肾脏替代治疗（RRT）。结果：6269例CS患者中，35%发生WRF，其中HF-CS为32%，AMI-CS为41%。发生WRF的患者更有可能从其他医院转院（63% vs 50%）。结论：WRF在HF-和AMI-CS中都是常见且有害的。考虑到早期与较差预后的关联，WRF可能不仅具有预后作用，而且在未来的CS研究中也代表了潜在的治疗靶点。

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

Journal of Cardiac Failure 医学-心血管系统

CiteScore

7.80

自引率

8.30%

发文量

653

审稿时长

21 days

期刊介绍： Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.