{"title":"急性心力衰竭患者入住重症监护室后的晚期肾损伤","authors":"Masaki Morooka, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Shohei Kawakami, Yu Michiura, Shogo Kamitani, Nobuaki Kobayashi, Kuniya Asai","doi":"10.1536/ihj.23-603","DOIUrl":null,"url":null,"abstract":"</p><p>Late kidney injury (LKI) in patients with acute heart failure (AHF) requiring intensive care is poorly understood.</p><p>We analyzed 821 patients with AHF who required intensive care. We defined LKI based on the ratio of the creatinine level 1 year after admission for AHF to the baseline creatinine level. The patients were categorized into 4 groups based on this ratio: no-LKI (< 1.5, <i>n</i> = 509), Class R (risk; ≥ 1.5, <i>n</i> = 214), Class I (injury; ≥ 2.0, <i>n</i> = 78), and Class F (failure; ≥ 3.0, <i>n</i> = 20). Median follow-up after admission for AHF was 385 (346-426) days. Multivariate logistic regression analysis revealed that acute kidney injury (AKI) during hospitalization (Class R, odds ratio [OR]: 1.710, 95% confidence interval [CI]: 1.138-2.571, <i>P</i> = 0.010; Class I, OR: 6.744, 95% CI: 3.739-12.163, <i>P</i> < 0.001; and Class F, OR: 9.259, 95% CI: 4.078-18.400, <i>P</i> < 0.001) was independently associated with LKI. Multivariate Cox regression analysis showed that LKI was an independent predictor of 3-year all-cause death after final follow-up (hazard ratio: 1.545, 95% CI: 1.099-2.172, <i>P</i> = 0.012). The rate of all-cause death was significantly lower in the no-AKI/no-LKI group than in the no-AKI/LKI group (<i>P</i> = 0.048) and in the AKI/no-LKI group than in the AKI/LKI group (<i>P</i> = 0.017).</p><p>The incidence of LKI was influenced by the presence of AKI during hospitalization, and was associated with poor outcomes within 3 years of final follow-up. In the absence of LKI, AKI during hospitalization for AHF was not associated with a poor outcome.</p>\n<p></p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":"148 1","pages":""},"PeriodicalIF":1.2000,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Late Kidney Injury After Admission to Intensive Care Unit for Acute Heart Failure\",\"authors\":\"Masaki Morooka, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Shohei Kawakami, Yu Michiura, Shogo Kamitani, Nobuaki Kobayashi, Kuniya Asai\",\"doi\":\"10.1536/ihj.23-603\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"</p><p>Late kidney injury (LKI) in patients with acute heart failure (AHF) requiring intensive care is poorly understood.</p><p>We analyzed 821 patients with AHF who required intensive care. We defined LKI based on the ratio of the creatinine level 1 year after admission for AHF to the baseline creatinine level. The patients were categorized into 4 groups based on this ratio: no-LKI (< 1.5, <i>n</i> = 509), Class R (risk; ≥ 1.5, <i>n</i> = 214), Class I (injury; ≥ 2.0, <i>n</i> = 78), and Class F (failure; ≥ 3.0, <i>n</i> = 20). Median follow-up after admission for AHF was 385 (346-426) days. Multivariate logistic regression analysis revealed that acute kidney injury (AKI) during hospitalization (Class R, odds ratio [OR]: 1.710, 95% confidence interval [CI]: 1.138-2.571, <i>P</i> = 0.010; Class I, OR: 6.744, 95% CI: 3.739-12.163, <i>P</i> < 0.001; and Class F, OR: 9.259, 95% CI: 4.078-18.400, <i>P</i> < 0.001) was independently associated with LKI. Multivariate Cox regression analysis showed that LKI was an independent predictor of 3-year all-cause death after final follow-up (hazard ratio: 1.545, 95% CI: 1.099-2.172, <i>P</i> = 0.012). The rate of all-cause death was significantly lower in the no-AKI/no-LKI group than in the no-AKI/LKI group (<i>P</i> = 0.048) and in the AKI/no-LKI group than in the AKI/LKI group (<i>P</i> = 0.017).</p><p>The incidence of LKI was influenced by the presence of AKI during hospitalization, and was associated with poor outcomes within 3 years of final follow-up. In the absence of LKI, AKI during hospitalization for AHF was not associated with a poor outcome.</p>\\n<p></p>\",\"PeriodicalId\":13711,\"journal\":{\"name\":\"International heart journal\",\"volume\":\"148 1\",\"pages\":\"\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2024-05-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International heart journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1536/ihj.23-603\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International heart journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1536/ihj.23-603","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Late Kidney Injury After Admission to Intensive Care Unit for Acute Heart Failure
Late kidney injury (LKI) in patients with acute heart failure (AHF) requiring intensive care is poorly understood.
We analyzed 821 patients with AHF who required intensive care. We defined LKI based on the ratio of the creatinine level 1 year after admission for AHF to the baseline creatinine level. The patients were categorized into 4 groups based on this ratio: no-LKI (< 1.5, n = 509), Class R (risk; ≥ 1.5, n = 214), Class I (injury; ≥ 2.0, n = 78), and Class F (failure; ≥ 3.0, n = 20). Median follow-up after admission for AHF was 385 (346-426) days. Multivariate logistic regression analysis revealed that acute kidney injury (AKI) during hospitalization (Class R, odds ratio [OR]: 1.710, 95% confidence interval [CI]: 1.138-2.571, P = 0.010; Class I, OR: 6.744, 95% CI: 3.739-12.163, P < 0.001; and Class F, OR: 9.259, 95% CI: 4.078-18.400, P < 0.001) was independently associated with LKI. Multivariate Cox regression analysis showed that LKI was an independent predictor of 3-year all-cause death after final follow-up (hazard ratio: 1.545, 95% CI: 1.099-2.172, P = 0.012). The rate of all-cause death was significantly lower in the no-AKI/no-LKI group than in the no-AKI/LKI group (P = 0.048) and in the AKI/no-LKI group than in the AKI/LKI group (P = 0.017).
The incidence of LKI was influenced by the presence of AKI during hospitalization, and was associated with poor outcomes within 3 years of final follow-up. In the absence of LKI, AKI during hospitalization for AHF was not associated with a poor outcome.
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