Skalsky Keren, Shiyovich Arthur, Shechter Alon, Gilutz Harel, Plakht Ygal
Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Biomedicines. 2024 Jul 5;12(7):1490. doi: 10.3390/biomedicines12071490.
We investigated the recovery pattern from acute kidney injury (AKI) following acute myocardial infarction (AMI) and its association with long-term mortality. The retrospective study included AMI patients (2002-2027), who developed AKI during hospitalization. Creatinine (Cr) measurements were collected and categorized into 24 h timeframes up to 7 days from AKI diagnosis. The following groups of recovery patterns were defined: rapid (24-48 h)/no rapid and early (72-144 h)/no early recovery. Specific cut-off points for recovery at each AKI stage and timeframe were determined through receiver operating characteristic (ROC) curves. The probability of long-term (up to 10 years) mortality as a post-AKI recovery was investigated using a survival approach. Out of 17,610 AMI patients, 1069 developed AKI. For stage 1 AKI, patients with a Cr ratio <1.5 at 24 h and/or <1.45 at 48 h were defined as 'rapid recovery'; for stages 2-3 AKI, a Cr ratio <2.5 at 96 h was defined as 'early recovery'. Mortality risk in stage 1 AKI was higher among the non-rapidly recovered: AdjHR = 1.407; 95% CI: 1.086-1.824; = 0.010. Among stages 2-3 AKI patients, the risk for long-term mortality was higher among patients who did not recover in the early period: AdjHR = 1.742; 95% CI: 1.085-2.797; = 0.022. The absence of rapid recovery in stage 1 AKI and lack of early recovery in stages 2-3 AKI are associated with higher long-term mortality.
我们研究了急性心肌梗死（AMI）后急性肾损伤（AKI）的恢复模式及其与长期死亡率的关联。这项回顾性研究纳入了2002年至2027年期间住院期间发生AKI的AMI患者。收集肌酐（Cr）测量值，并将其按从AKI诊断起长达7天的24小时时间段进行分类。定义了以下几组恢复模式：快速恢复（24 - 48小时）/非快速恢复，以及早期恢复（72 - 144小时）/非早期恢复。通过受试者工作特征（ROC）曲线确定每个AKI阶段和时间段恢复的特定截断点。采用生存分析方法研究AKI恢复后长期（长达10年）死亡的概率。在17610例AMI患者中，1069例发生了AKI。对于1期AKI，24小时时Cr比值<1.5且/或48小时时<1.45的患者被定义为“快速恢复”；对于2 - 3期AKI，96小时时Cr比值<2.5被定义为“早期恢复”。1期AKI中未快速恢复的患者死亡风险更高：调整后风险比（AdjHR）= 1.407；95%置信区间（CI）：1.086 - 1.824；P = 0.010。在2 - 3期AKI患者中，早期未恢复的患者长期死亡风险更高：AdjHR = 1.742；95% CI：1.085 - 2.797；P = 0.022。1期AKI缺乏快速恢复以及2 - 3期AKI缺乏早期恢复与更高的长期死亡率相关。
