Tien Yu-Tzu, Chen Wen-Jone, Huang Chien-Hua, Chen Wei-Ting, Ong Hooi-Nee, Huang Tao-Ming, Chang Wei-Tien, Tsai Min-Shan
Department of Emergency Medicine, National Taiwan University Medical College and Hospital, 100233 Taipei, Taiwan.
Department of Internal Medicine (Cardiology Division), National Taiwan University Medical College and Hospital, 100233 Taipei, Taiwan.
Rev Cardiovasc Med. 2024 Jan 4;25(1):4. doi: 10.31083/j.rcm2501004. eCollection 2024 Jan.
Postarrest acute kidney injury (AKI) is a major health burden because it is associated with prolonged hospitalization, increased dialysis requirement, high mortality, and unfavorable neurological outcomes. Managing hemodynamic instability during the early postarrest period is critical; however, the role of quantified vasopressor dependence in AKI development in relation to illness severity remains unclear.
A retrospective, observational cohort study that enrolled 411 non-traumatic adult cardiac arrest survivors without pre-arrest end-stage kidney disease between January 2017 and December 2019, grouped according to their baseline kidney function. The criteria for kidney injury were based on the Kidney Disease: Improving Global Outcomes definition and AKI staging system. The degree of vasopressor dependence within the first 24 h following return of spontaneous circulation (ROSC) was presented using the maximum vasoactive-inotropic score ( ).
Of the 411 patients, 181 (44%) had early AKI after ROSC. Patients with AKI showed an increased risk of in-hospital mortality (adjusted OR [aOR] 5.40, 95% CI 3.36-8.69, 0.001) and unfavorable neurological outcome (aOR 5.70, 95% CI 3.45-9.43, 0.001) compared to patients without AKI. The risk of adverse outcomes increased with illness severity. Patients with vasopressor support had an increased risk of early AKI. A low was associated with AKI stage 1-2 (aOR 2.51, 95% CI 1.20-5.24), whereas a high was associated with an increased risk for AKI stage 3 (aOR 2.46, 95% CI 1.28-4.75).
Early AKI is associated with an increased risk of in-hospital mortality and unfavorable neurologic recovery in cardiac arrest survivors. Postarrest is an independent predictor of the development and severity of AKI following ROSC, regardless of baseline kidney function.
心脏骤停后急性肾损伤（AKI）是一项重大的健康负担，因为它与住院时间延长、透析需求增加、高死亡率以及不良神经学预后相关。在心脏骤停后的早期阶段管理血流动力学不稳定至关重要；然而，量化的血管升压药依赖在与疾病严重程度相关的AKI发展中的作用仍不清楚。
一项回顾性观察队列研究，纳入了2017年1月至2019年12月期间411例无心脏骤停前终末期肾病的非创伤性成年心脏骤停幸存者，并根据其基线肾功能进行分组。肾损伤标准基于《肾脏病：改善全球预后》定义和AKI分期系统。使用最大血管活性-正性肌力评分（ ）来表示自主循环恢复（ROSC）后最初24小时内血管升压药的依赖程度。
在411例患者中，181例（44%）在ROSC后发生早期AKI。与无AKI的患者相比，AKI患者的院内死亡风险增加（校正比值比[aOR] 5.40，95%置信区间3.36 - 8.69， 0.001）以及不良神经学预后风险增加（aOR 5.70，95%置信区间3.45 - 9.43， 0.001）。不良结局风险随疾病严重程度增加。接受血管升压药支持的患者发生早期AKI的风险增加。低 与1 - 2期AKI相关（aOR 2.51，95%置信区间1.20 - 5.24），而高 与3期AKI风险增加相关（aOR 2.46，95%置信区间1.28 - 4.75）。
早期AKI与心脏骤停幸存者的院内死亡风险增加和不良神经功能恢复相关。心脏骤停后 是ROSC后AKI发生和严重程度的独立预测因素，无论基线肾功能如何。
