DOI: 10.2459/jcm.0000000000001893 ISSN: 1558-2027

Acute kidney injury and renal function changes in cardiogenic shock

Mauro Riccardi, Dario S. Cani, Benedetta Thiébat, Lorenza Biava, Lorenzo Zaccaro, Matteo P. Vaira, Paolo Scacciatella, Andrea Montisci, Sergio Cattaneo, Riccardo M. Inciardi, Carlo M. Lombardi, Marianna Adamo, Marco Metra, Matteo Pagnesi
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Aims

To evaluate the prognostic role of acute kidney injury (AKI) and estimated glomerular filtration rate (eGFR) in patients with cardiogenic shock (CS).

Methods

All consecutive patients admitted for CS were retrospectively included. The association of AKI development within 48 h from admission with in-hospital mortality was evaluated. Predictors of AKI and the role of eGFR reassessment were also evaluated.

Results

A total of 313 patients with CS were included. AKI was independently associated with increased in-hospital mortality [adjusted odds ratio (OR) for AKI vs. no-AKI 3.38, 95% confidence interval (CI) 1.82–6.28, P < 0.001]. The risk of mortality progressively increased at increasing AKI stages ( P < 0.001). Higher eGFR was independently associated with a decreased risk of in-hospital mortality when considering either baseline values, 24-h values and 48-h values. The accuracy of 48-h eGFR in predicting in-hospital mortality [area under the curve (AUC) 0.789] was higher compared with 24-h eGFR (AUC 0.754) and baseline eGFR (AUC 0.686). At multivariable logistic regression analysis, chronic kidney disease (CKD) and central venous pressure (CVP) were associated with a higher likelihood of AKI, whereas higher mean arterial pressure (MAP) was associated with a lower likelihood.

Conclusions

In patients with CS, AKI development within 48 h was independently associated with in-hospital mortality and the risk progressively increased at increasing AKI stages. An eGFR reassessment at 48 h had a higher accuracy for predicting mortality compared with eGFR values at admission and 24 h. Previous CKD, MAP and CVP were the predictors of AKI development.

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