Bjørn Maria, Kunkel Joakim Bo, Helgestad Ole, Josiassen Jakob, Jeppesen Karoline Korsholm, Holmvang Lene, Jensen Lisette Okkels, Schmidt Henrik, Fosbøl Emil, Hassager Christian, Møller Jacob Eifer, Ravn Hanne Berg
Department of Anesthesia and Intensive Care, Odense University Hospital, J.B. Winsløws Vej 4, Odense C 5000, Denmark.
Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
Eur Heart J Acute Cardiovasc Care. 2025 Aug 6;14(7):385-391. doi: 10.1093/ehjacc/zuaf048.
The recent DanGer shock trial found reduced mortality, but increased risk of acute kidney injury (AKI) in patients treated with a microaxial flow pump after an acute myocardial infarct with cardiogenic shock. AKI has previously been associated with increased short-term mortality, whereas data on long-term outcomes are sparse. We aimed to describe the frequency of AKI and associated risk factors as well as long-term mortality and morbidity.
A retrospective observational study comprising patients admitted with acute myocardial infarction cardiogenic shock in Denmark between 2010 and 2017 with data on kidney function from the RETROSHOCK cohort. National health registry data enabled 10-year follow-up to assess mortality and morbidity. Kaplan-Meier estimates and competing risks regression were used to evaluate the association of AKI with the incidence of short- and long-term mortality, chronic kidney disease (CKD) and dialysis. Among 1473 patients, 44% developed AKI, 25% required renal replacement therapy (RRT). AKI development was associated with increasing age, diabetes, low ejection fraction and high lactate levels on admission (P < 0.05). Thirty-days mortality as well as mortality at 1-, 5-, and 10-years follow-up was significantly increased in patients with AKI; at 10 years follow-up mortality was increased by more than 30% (P < 0.001). The 10-year cumulative incidence of both CKD and dialysis, accounting for the competing risk of death, was significantly higher in patients treated with RRT during admission (P < 0.001).
AKI was associated with increased short- and long-term mortality and morbidity, including CKD and dialysis, but not new cardiovascular events.
近期的DanGer休克试验发现，急性心肌梗死合并心源性休克患者接受微轴流泵治疗后死亡率降低，但急性肾损伤（AKI）风险增加。AKI此前与短期死亡率增加有关，而关于长期预后的数据较少。我们旨在描述AKI的发生率及相关危险因素，以及长期死亡率和发病率。
一项回顾性观察性研究，纳入2010年至2017年在丹麦因急性心肌梗死合并心源性休克入院的患者，数据来自RETROSHOCK队列的肾功能数据。国家健康登记数据可进行10年随访以评估死亡率和发病率。采用Kaplan-Meier估计法和竞争风险回归分析来评估AKI与短期和长期死亡率、慢性肾脏病（CKD）及透析发生率之间的关联。在1473例患者中，44%发生了AKI，25%需要肾脏替代治疗（RRT）。AKI的发生与年龄增长、糖尿病、入院时射血分数低及乳酸水平高有关（P<0.05）。发生AKI的患者30天死亡率以及1年、5年和10年随访时的死亡率显著增加；10年随访时死亡率增加超过30%（P<0.001）。在入院期间接受RRT治疗的患者中，考虑到死亡的竞争风险，CKD和透析的10年累积发生率显著更高（P<0.001）。
AKI与短期和长期死亡率及发病率增加有关，包括CKD和透析，但与新发心血管事件无关。
