Kaur Gagan, Shah Rushi P, Shakya Aabha, Loh Chia Chi, Kommuru Sravani, Aziz Syed Nurul, Patel Viralkumar
Medicine and Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND.
Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND.
Cureus. 2022 Jul 1;14(7):e26490. doi: 10.7759/cureus.26490. eCollection 2022 Jul.
Objective To delineate the differences in demographic characteristics and hospitalization outcomes in patients with acute myocardial infarction by comorbid acute kidney injury (AKI) and to explore the risk factors for in-hospital mortality due to AKI in acute myocardial infarction (AMI) inpatients. Methods We conducted a retrospective cross-sectional study using a nationwide inpatient sample and included 77,585 adult inpatients with AMI and further divided by the presence of a co-diagnosis of AKI. A logistic regression model was used to evaluate the odds ratio (OR) of the association between in-hospital mortality and AKI and other comorbidities. Results The prevalence of AKI in AMI inpatients during hospitalization was 11.69%. Among AMI inpatients with AKI, it was prevalent in males (73.9%) and whites (48.8%). Patients with AKI had a higher prevalence of complicated comorbid hypertension (58.7%), diabetes with complications (34.8%), cardiogenic shock (17.4%), and drug abuse (12.3%). Male patients had lower odds of in-hospital mortality (OR 0.69; 95% Cl 0.61-0.79) compared to females. Hispanics had a higher association with mortality (OR 1.45; 95% Cl 1.21-1.74) than whites and other races/ethnicities. Patients who developed cardiogenic shock were at 17 times higher odds of in-hospital mortality (OR 17.25; 95% CI 15.14-19.67), followed by AKI (OR 4.64; 95% CI 4.06-5.31), and alcohol abuse (OR 1.29; 95% CI 1.03-1.64). The in-hospital mortality rate among AMI inpatients with AKI (7.6%) was significantly higher compared to that seen in the non-AKI cohort (0.9%). Conclusion AMI inpatients with AKI during hospitalization was prevalent in males and whites. Among the demographic risk factors, females and Hispanics had a higher likelihood of in-hospital mortality during the inpatient management of AMI. Cardiogenic shock and AKI increased the odds of in-hospital mortality compared to other comorbidities in AMI inpatients.
目的 描述合并急性肾损伤（AKI）的急性心肌梗死患者的人口统计学特征及住院结局差异，并探讨急性心肌梗死（AMI）住院患者因AKI导致院内死亡的危险因素。方法 我们使用全国住院患者样本进行了一项回顾性横断面研究，纳入77585例成年AMI住院患者，并根据是否合并AKI诊断进一步分组。采用逻辑回归模型评估院内死亡与AKI及其他合并症之间关联的比值比（OR）。结果 AMI住院患者中AKI的患病率为11.69%。在合并AKI的AMI住院患者中，男性（73.9%）和白人（48.8%）中更为常见。合并AKI的患者中，复杂合并症高血压（58.7%）、糖尿病伴并发症（34.8%）、心源性休克（17.4%）和药物滥用（12.3%）的患病率更高。与女性相比，男性患者院内死亡几率较低（OR 0.69；95%CI 0.61 - 0.79）。西班牙裔与死亡率的关联（OR 1.45；95%CI 1.21 - 1.74）高于白人和其他种族/族裔。发生心源性休克的患者院内死亡几率高出17倍（OR 17.25；95%CI 15.14 - 19.67），其次是AKI（OR 4.64；95%CI 4.06 - 5.31）和酒精滥用（OR 1.29；95%CI 1.03 - 1.64）。合并AKI的AMI住院患者的院内死亡率（7.6%）显著高于未合并AKI的队列（0.9%）。结论 住院期间合并AKI的AMI住院患者在男性和白人中更为常见。在人口统计学危险因素中，女性和西班牙裔在AMI住院治疗期间院内死亡的可能性更高。与AMI住院患者的其他合并症相比，心源性休克和AKI增加了院内死亡几率。
