Marenzi Giancarlo, Cosentino Nicola, Marinetti Andrea, Leone Antonio M, Milazzo Valentina, Rubino Mara, De Metrio Monica, Cabiati Angelo, Campodonico Jeness, Moltrasio Marco, Bertoli Silvio, Cecere Milena, Mosca Susanna, Marana Ivana, Grazi Marco, Lauri Gianfranco, Bonomi Alice, Veglia Fabrizio, Bartorelli Antonio L
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Int J Cardiol. 2017 Mar 1;230:255-261. doi: 10.1016/j.ijcard.2016.12.130. Epub 2016 Dec 23.
We evaluated the rate of use, clinical predictors, and in-hospital outcome of renal replacement therapy (RRT) in acute myocardial infarction (AMI) patients.
All consecutive AMI patients admitted to the Coronary Care Unit between January 1st, 2005 and December 31st, 2015 were identified through a search of our prospectively collected clinical database. Patients were grouped according to whether they required RRT or not.
Two-thousand-eight-hundred-thirty-nine AMI patients were included. Eighty-three (3%) AMI patients underwent RRT. Variables confirmed at cross validation analysis to be associated with RRT were: admission creatinine >1.5mg/dl (OR 16.9, 95% CI 10.4-27.3), cardiogenic shock (OR 23.0, 95% CI 14.4-36.8), atrial fibrillation (OR 8.6, 95% CI 5.5-13.4), mechanical ventilation (OR 22.6, 95% CI 14.2-36.0), diabetes mellitus (OR 4.8, 95% CI 3.1-7.4), and left ventricular ejection fraction <40% (OR 9.1, 95% CI 5.6-14.7). The AUC for RRT with the combination of these predictors was 0.96 (95% CI 0.94-0.97; P<0.001). In-hospital mortality was significantly higher in RRT patients (41% vs. 2.1%, P<0.001). Oligoanuria as indication for RRT (OR 5.1, 95% CI 1.7-15.4), atrial fibrillation (OR 4.3, 95% CI 1.6-11.5), mechanical ventilation (OR 20.8, 95% CI 6.1-70.4), and cardiogenic shock (OR 12.9, 95% CI 4.4-38.3) independently predicted mortality in RRT-treated patients. The AUC for in-hospital mortality prediction with the combination of these variables was 0.92 (95% CI 0.87-0.98; P<0.001).
Patients with AMI undergoing RRT had strikingly high in-hospital mortality. Use of RRT and its associated mortality were accurately predicted by easily obtainable clinical variables.
我们评估了急性心肌梗死（AMI）患者接受肾脏替代治疗（RRT）的使用率、临床预测因素及院内结局。
通过检索我们前瞻性收集的临床数据库，确定了2005年1月1日至2015年12月31日期间入住冠心病监护病房的所有连续AMI患者。根据患者是否需要RRT进行分组。
纳入了2839例AMI患者。83例（3%）AMI患者接受了RRT。经交叉验证分析确定与RRT相关的变量有：入院时肌酐>1.5mg/dl（比值比[OR]16.9，95%置信区间[CI]10.4 - 27.3）、心源性休克（OR 23.0，95%CI 14.4 - 36.8）、心房颤动（OR 8.6，95%CI 5.5 - 13.4）、机械通气（OR 22.6，95%CI 14.2 - 36.0）、糖尿病（OR 4.8，95%CI 3.1 - 7.4）以及左心室射血分数<40%（OR 9.1，95%CI 5.6 - 14.7）。这些预测因素联合用于RRT的曲线下面积（AUC）为0.96（95%CI 0.94 - 0.97；P<0.001）。RRT患者的院内死亡率显著更高（41%对2.1%，P<0.001）。以少尿作为RRT指征（OR 5.1，95%CI 1.7 - 15.4）、心房颤动（OR 4.3, 95%CI 1.6 - 11.5）、机械通气（OR 20.8, 95%CI 6.1 - 70.4）以及心源性休克（OR 12.9, 95%CI 4.4 - 38.3）独立预测了接受RRT治疗患者中的死亡率。这些变量联合用于院内死亡率预测的AUC为0.92（95%CI 0.87 - 0.98；P<0.001）。
接受RRT的AMI患者院内死亡率极高。通过易于获得的临床变量可准确预测RRT的使用及其相关死亡率。
