TY - JOUR
T1 - Acute kidney injury in cardiogenic shock
T2 - definitions, incidence, haemodynamic alterations, and mortality
AU - Tarvasmäki, Tuukka
AU - Haapio, Mikko
AU - Mebazaa, Alexandre
AU - Sionis, Alessandro
AU - Silva-Cardoso, José
AU - Tolppanen, Heli
AU - Lindholm, Matias G.
AU - Pulkki, Kari
AU - Parissis, John
AU - Harjola, Veli Pekka
AU - Lassus, Johan
AU - Banaszewski, Marek
AU - Kober, Lars
AU - Metra, Marco
AU - Di Somma, Salvatore
AU - Spinar, Jindrich
AU - Koniari, Katerina
AU - Voumvourakis, Astrinos
AU - Karavidas, Apostolos
AU - Sans-Rosello, Jordi
AU - Vila, Montserrat
AU - Duran-Cambra, Albert
AU - Metra, Marco
AU - Bulgari, Michela
AU - Lazzarini, Valentina
AU - Parenica, Jiri
AU - Stipal, Roman
AU - Ludka, Ondrej
AU - Palsuva, Marie
AU - Ganovska, Eva
AU - Kubena, Petr
AU - Lindholm, Matias G.
AU - Hassager, Christian
AU - Bäcklund, Tom
AU - Jurkko, Raija
AU - Järvinen, Kristiina
AU - Nieminen, Tuomo
AU - Pulkki, Kari
AU - Soininen, Leena
AU - Sund, Reijo
AU - Tierala, Ilkka
AU - Tolonen, Jukka
AU - Varpula, Marjut
AU - Korva, Tuomas
AU - Pitkälä, Anne
AU - Marino, Rossella
AU - Sousa, Alexandra
AU - Sousa, Carla
AU - Paiva, Mariana
AU - Rangel, Inês
AU - on behalf of the CardShock Study Investigators
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - Acute kidney injury
KW - Cardiogenic shock
KW - Haemodynamics
KW - KDIGO
KW - Mortality
KW - Urine output
U2 - 10.1002/ejhf.958
DO - 10.1002/ejhf.958
M3 - Journal article
C2 - 28960633
AN - SCOPUS:85044256233
SN - 1388-9842
VL - 20
SP - 572
EP - 581
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 3
ER -