Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission

作者：Marenzi Giancarlo^*; Assanelli Emilio; Campodonico Jeness; De Metrio Monica; Lauri Gianfranco; Marana Ivana; Moltrasio Marco; Rubino Mara; Veglia Fabrizio; Montorsi Piero; Bartorelli Antonio L

来源：Critical Care Medicine, 2010, 38(2): 438-444.

DOI：10.1097/CCM.0b013e3181b9eb3b

• acute kidney injury
• cardiogenic shock
• primary percutaneous coronary intervention
• ST-elevation acute myocardial infarction
• intra-aortic balloon pump

Objective: To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS).
Design: Prospective study.
Setting: Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.
Patients: Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI).
Interventions: None.
Measurements and Main Results: We measured serum creatine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine > 25% from baseline.
Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age > 75 yrs (p = .005), left ventricular ejection fraction <= 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p < .001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p < .001).
Conclusions: In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis. (Crit Care Med 2010; 38:438-444)

• 出版日期2010-2