The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Third Department of Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital Vienna, Vienna, Austria.
Cardiorenal Med. 2019;9(3):160-167. doi: 10.1159/000494807. Epub 2019 Mar 7.
Data on the associations between serum osmolality (sOsmo) and acute kidney injury (AKI) as well as short- and long-term mortality in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are limited.
To investigate the association between sOsmo and development of AKI and clinical outcomes in patients undergoing PCI.
We investigated 1,927 consecutive patients undergoing PCI from the registry of a single center. Patients were divided into quartiles according to sOsmo at admission (Q1-Q4). sOsmo was calculated using the following equation: (1.86 × serum sodium [mmol/L]) + (glucose [mg/dL] / 18) + (blood urea nitrogen [mg/dL] / 2.8) + 9. The primary endpoint was AKI, per Kidney Disease: Improving Global Outcomes (KDIGO) definition. The secondary endpoints were 30-day and 1-year all-cause mortality.
Patients with the highest sOsmo (Q4) were older and more likely female, with significantly more cardiovascular risk factors and comorbidities compared to those with lower sOsmo (Q1-Q3). Incidence of AKI was highest in Q4 and lowest in Q2. In the multivariate logistic regression model, high sOsmo independently predicted the development of AKI (OR 2.00, 95% CI 1.26-3.19, p = 0.003). Patients with Q4 had a higher risk of 1-year mortality compared to patients with Q2 (HR 2.11, 95% CI 1.10-4.15; p = 0.031), but not after adding AKI to the multivariate model (HR 1.71, 95% CI 0.87-3.39; p = 0.12).
sOsmo is a valid and easily obtainable predictor of AKI after PCI. High sOsmo is associated with increased risk of AKI and 1-year mortality in patients undergoing PCI. Further research is warranted to clarify whether the use of an sOsmo-directed hydration protocol might reduce the incidence of AKI in patients undergoing PCI.
有关血清渗透压（sOsmo）与接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者急性肾损伤（AKI）以及短期和长期死亡率之间关联的数据有限。
研究 sOsmo 与 PCI 患者 AKI 发展和临床结局之间的关系。
我们调查了来自单一中心登记处的 1927 例连续接受 PCI 的患者。根据入院时的 sOsmo 将患者分为四组（Q1-Q4）。sOsmo 通过以下公式计算：（1.86×血清钠[mmol/L]）+（葡萄糖[mg/dL] / 18）+（血尿素氮[mg/dL] / 2.8）+9。主要终点为根据肾脏病：改善全球预后（KDIGO）定义的 AKI。次要终点为 30 天和 1 年全因死亡率。
sOsmo 最高的患者（Q4）年龄较大，更可能为女性，与 sOsmo 较低的患者（Q1-Q3）相比，具有更多的心血管危险因素和合并症。AKI 的发生率在 Q4 最高，在 Q2 最低。在多变量逻辑回归模型中，高 sOsmo 独立预测 AKI 的发生（OR 2.00，95%CI 1.26-3.19，p=0.003）。与 Q2 患者相比，Q4 患者 1 年死亡率更高（HR 2.11，95%CI 1.10-4.15；p=0.031），但在将 AKI 添加到多变量模型后并非如此（HR 1.71，95%CI 0.87-3.39；p=0.12）。
sOsmo 是 PCI 后 AKI 的有效且易于获得的预测指标。高 sOsmo 与 PCI 患者 AKI 发生率增加和 1 年死亡率增加相关。需要进一步研究以明确是否使用 sOsmo 指导的水化方案可降低 PCI 患者 AKI 的发生率。
