Complementary prognostic value of urine output and renal function in heart failure-related cardiogenic shock
T Ris, J Hoogland, T Balthazar, F Pappalardo, P Knaapen, M C Van De Veerdonk, A NapAbstract
Background and study aim
Renal impairment is common in heart failure–related cardiogenic shock (HF-CS), but its prognostic value in earlier stages of HF-CS is unclear. We investigated the prognostic value of renal dysfunction (RD) at HF-CS diagnosis, as well as creatinine- and oliguria-based acute kidney injury (AKI) within the first 24 hours after diagnosis.
Methods
We studied 394 patients with HF-CS, excluding those with out-of-hospital cardiac arrest or invasive ventilation at diagnosis. RD was staged per KDIGO chronic kidney disease criteria (Stage I trough Stage V). AKIcrea was defined as a creatinine increase ≥26.5 μmol/L (0.3 mg/dL), and AKIuo as urine output <0.5 mL/kg/h over a 24-hour period. The primary outcome was 30-day mortality, while the secondary outcome was 1-year mortality.
Results
Kaplan–Meier survival curves for RD at the time of HF-CS diagnosis, AKIcrea, and AKIuo are shown in Figure 1. At HF-CS diagnosis, only RD KDIGO stage V eGFR (<15 mL/min/1.73 m² or on dialysis) was associated with 30-day mortality (adjusted HR, 3.28; 95% CI, 1.66–6.47; P <0.001). AKIcrea was not associated with 30-day mortality (adjusted HR, 1.05; 95% CI, 0.66–1.66; P=0.853). In contrast, AKIuo was associated with a higher risk of death (adjusted HR, 1.92; 95% CI, 1.22– 3.01; P=0.004), with the greatest risk observed among patients with UO <0.3 mL/kg/h (adjusted HR, 2.42; 95% CI, 1.43–4.12; P=0.001). No interaction was observed between UO and loop diuretics for mortality (P = 0.893). At 1 year, both AKIcrea (adjusted HR 1.45; 95% CI, 1.04– 2.02; P=0.028) and AKIuo (adjusted HR, 1.65; 95% CI, 1.13–2.40; P=0.009) were associated with increased mortality.
Conclusions
In HF-CS, oliguria during the first 24 hours of CS management was a strong predictor of 30-day mortality, independent of diuretic dose, as was RD stage V. Creatinine-based AKI was not associated with 30-day mortality. Both AKIcrea and AKIuo were independent predictors of mortality at 1 year.Graphical abstractFor image description, please refer to the figure legend and surrounding text.Figure 1For image description, please refer to the figure legend and surrounding text.