Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY.
J Thorac Cardiovasc Surg. 2017 Sep;154(3):856-864.e4. doi: 10.1016/j.jtcvs.2017.04.042. Epub 2017 Apr 25.
Although the outcomes of patients with cardiogenic shock remain poor, short-term mechanical circulatory support has become an increasingly popular modality for hemodynamic assistance and organ preservation. Because the kidney is exquisitely sensitive to poor perfusion, acute kidney injury is a common sequela of cardiogenic shock. This study examines the incidence and clinical impact of acute kidney injury in patients with short-term mechanical circulatory support for cardiogenic shock.
Retrospective review was performed of 293 consecutive patients with cardiogenic shock who were treated with short-term mechanical circulatory support. The well-validated 2014 Kidney Disease Improving Global Outcomes criteria were used to stage acute kidney injury. Outcomes of interest were long-term mortality and renal recovery.
Acute kidney injury developed in 177 of 293 patients (60.4%), of whom 113 (38.6%) were classified with stage 3 (severe). Kaplan-Meier survival estimates indicated a 1-year survival of 49.2% in the nonsevere (stages 0-2) acute kidney injury cohort versus 27.3% in the severe acute kidney injury cohort (P < .001). Multivariable Cox regression demonstrated that severe acute kidney injury was a predictor of long-term mortality (hazard ratio, 1.54; confidence interval, 1.10-2.14; P = .011). Among hospital survivors, renal recovery occurred more frequently (82.4% vs 63.2%, P = .069) and more quickly (5.6 vs 24.5 days, P < .0001) in the nonsevere than in the severe acute kidney injury group.
Acute kidney injury is common and frequently severe in patients in cardiogenic shock treated with short-term mechanical circulatory support. Milder acute kidney injury resolves with survival comparable to patients without acute kidney injury. Severe acute kidney injury is an independent predictor of long-term mortality. Nonetheless, many surviving patients with acute kidney injury do experience gradual renal recovery.
尽管心源性休克患者的预后仍然较差，但短期机械循环支持已成为血液动力学辅助和器官保护的一种越来越受欢迎的方式。由于肾脏对灌注不良极为敏感，急性肾损伤是心源性休克的常见后遗症。本研究探讨了短期机械循环支持治疗心源性休克患者中急性肾损伤的发生率和临床影响。
对 293 例连续心源性休克患者进行回顾性分析，这些患者接受了短期机械循环支持治疗。使用经过充分验证的 2014 年肾脏病改善全球结局标准对急性肾损伤进行分期。感兴趣的结果是长期死亡率和肾脏恢复。
293 例患者中有 177 例（60.4%）发生急性肾损伤，其中 113 例（38.6%）为 3 期（严重）。Kaplan-Meier 生存估计表明，非严重（0-2 期）急性肾损伤组的 1 年生存率为 49.2%，而严重急性肾损伤组为 27.3%（P<.001）。多变量 Cox 回归显示，严重急性肾损伤是长期死亡率的预测因素（危险比，1.54；置信区间，1.10-2.14；P=.011）。在住院幸存者中，非严重急性肾损伤组的肾脏恢复更常见（82.4% vs 63.2%，P=.069）且更快（5.6 天 vs 24.5 天，P<.0001）。
在接受短期机械循环支持治疗的心源性休克患者中，急性肾损伤很常见，且常较为严重。轻度急性肾损伤的存活率与无急性肾损伤的患者相当。严重急性肾损伤是长期死亡率的独立预测因素。尽管如此，许多急性肾损伤存活患者确实经历了逐渐的肾脏恢复。
