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Background <p>Cardiogenic shock (CS) after myocardial infarction remains associated with high mortality. Acute kidney injury (AKI), a common complication, substantially impacts outcomes. We investigated the prognostic relevance of AKI and renal replacement therapy (RRT) in CS.</p> Methods <p>In this retrospective study, 369 patients with infarct-related CS admitted to a tertiary center were analyzed. AKI was defined by KDIGO criteria. Clinical, laboratory, and hemodynamic data, including RRT use and in-hospital outcomes, were evaluated. Multivariable logistic regression identified independent predictors of AKI and RRT. Discriminatory power was assessed using AUC.</p> Results <p>AKI occurred in 42.8% of patients (n = 143), with 60.1% developing AKI within 48&#xa0;h and 35.0% classified as stage 3. AKI patients were older (70.5 vs. 67.2&#xa0;years; p = 0.010), had more pre-existing CKD (100 vs. 83.3%; p = 0.002), and required longer ventilation (168 vs. 65.5&#xa0;h; p &lt; 0.001). Inflammatory, renal, and perfusion markers were significantly elevated from day 2 onward. RRT was initiated in 8.9% overall and 23.1% of AKI patients, with 60.6% mortality. Predictors of AKI included age (OR 2.40; 95% CI 1.10–5.12) and norepinephrine dose (OR 1.001 per µg/kg; p = 0.042; AUC = 0.71). Predictors of RRT were admission creatinine (OR 2.05 per mg/dL; p = 0.003) and absence of CPR (OR 0.22; p = 0.008; AUC = 0.75). Overall mortality was 57.7%, higher in women (66.4% vs. 53.4%; p = 0.021).</p> Conclusions <p>AKI is common in infarct-related CS and linked to poor outcomes. Early identification of high-risk patients may enable timely renoprotective strategies.</p>

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Acute kidney injury as a prognostic determinant in cardiogenic shock: a cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月12日

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  • Priyanka Boettger,
  • Henriette Preusse-Sondermann,
  • Jamschid Sedighi,
  • Utku Bayram,
  • Henning Lemm,
  • Samuel Sossalla,
  • Michael Buerke

摘要

Background

Cardiogenic shock (CS) after myocardial infarction remains associated with high mortality. Acute kidney injury (AKI), a common complication, substantially impacts outcomes. We investigated the prognostic relevance of AKI and renal replacement therapy (RRT) in CS.

Methods

In this retrospective study, 369 patients with infarct-related CS admitted to a tertiary center were analyzed. AKI was defined by KDIGO criteria. Clinical, laboratory, and hemodynamic data, including RRT use and in-hospital outcomes, were evaluated. Multivariable logistic regression identified independent predictors of AKI and RRT. Discriminatory power was assessed using AUC.

Results

AKI occurred in 42.8% of patients (n = 143), with 60.1% developing AKI within 48 h and 35.0% classified as stage 3. AKI patients were older (70.5 vs. 67.2 years; p = 0.010), had more pre-existing CKD (100 vs. 83.3%; p = 0.002), and required longer ventilation (168 vs. 65.5 h; p < 0.001). Inflammatory, renal, and perfusion markers were significantly elevated from day 2 onward. RRT was initiated in 8.9% overall and 23.1% of AKI patients, with 60.6% mortality. Predictors of AKI included age (OR 2.40; 95% CI 1.10–5.12) and norepinephrine dose (OR 1.001 per µg/kg; p = 0.042; AUC = 0.71). Predictors of RRT were admission creatinine (OR 2.05 per mg/dL; p = 0.003) and absence of CPR (OR 0.22; p = 0.008; AUC = 0.75). Overall mortality was 57.7%, higher in women (66.4% vs. 53.4%; p = 0.021).

Conclusions

AKI is common in infarct-related CS and linked to poor outcomes. Early identification of high-risk patients may enable timely renoprotective strategies.