Back to Search
Start Over
Acute kidney injury in cardiogenic shock: definitions, incidence, haemodynamic alterations, and mortality.
- Source :
-
European Journal of Heart Failure . Mar2018, Vol. 20 Issue 3, p572-581. 10p. 2 Charts, 3 Graphs. - Publication Year :
- 2018
-
Abstract
- Aims: To investigate the incidence, haemodynamic alterations and 90‐day mortality of acute kidney injury (AKI) in patients with cardiogenic shock. We assessed the utility of creatinine, urine output (UO) and cystatin C (CysC) definitions of AKI in prognostication. Methods and results: Cardiogenic shock patients with serial plasma samples (n = 154) from the prospective multicenter CardShock study were included in the analysis. Acute kidney injury was defined and staged according to the KDIGO criteria by creatinine (AKIcrea) and/or UO (AKIUO). CysC‐based AKI (AKICysC) was defined similarly to AKIcrea. Changes in haemodynamic parameters were assessed over time from baseline until 96 h. Mean age of the study population was 66 ± 12 years and 74% were men. Median baseline creatinine was 1.12 [interquartile range (IQR) 0.87–1.54] mg/dL and CysC 1.19 (IQR 0.90–1.69) mg/L. The 90‐day mortality was 38%. The incidences for AKI were: AKIcrea 31%, AKIUO 50%, and AKICysc 33%. AKIcrea [odds ratio (OR) 12.2, 95% confidence interval (CI) 4.1–36.0] and AKICysC (OR 2.5, 95% CI 1.1–6.1), but not AKIUO, were independent predictors of mortality. However, a stricter UO cut‐off of <0.3 mL/kg/h for 6 h was independently associated with 90‐day mortality (OR 3.6, 95% CI 1.4–9.3). Development of AKI was associated with persistently elevated central venous pressure and decreased cardiac index and mean arterial pressure. Conclusions: Acute kidney injury is frequent in patients with cardiogenic shock and especially AKIcrea predicts poor outcome. The KDIGO UO criterion seems, however, rather liberal and a stricter AKI definition of UO <0.3 mL/kg/h for at least 6 h seems more useful for mortality risk prediction. Haemodynamic alterations reflecting venous congestion and hypoperfusion were associated with AKI. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CARDIOGENIC shock
*HEMODYNAMIC monitoring
*KIDNEY injuries
*CREATININE
*MORTALITY
Subjects
Details
- Language :
- English
- ISSN :
- 13889842
- Volume :
- 20
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- European Journal of Heart Failure
- Publication Type :
- Academic Journal
- Accession number :
- 128732890
- Full Text :
- https://doi.org/10.1002/ejhf.958