Tadokoro Naoki, Saku Keita, Tonai Kohei, Tadokoro Yuki, Kutsuzawa Reiko, Fukushima Satsuki
Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan.
Front Cardiovasc Med. 2025 Jun 13;12:1580599. doi: 10.3389/fcvm.2025.1580599. eCollection 2025.
Post-cardiotomy cardiogenic shock (PCCS) is a serious condition that necessitates veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Although acute kidney injury (AKI) often complicates PCCS, its specific effects on patient outcomes remain unclear. This study seeks to evaluate the impact of AKI on 90-day mortality.
This retrospective study included 91 patients with postoperative cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation following cardiac surgery between 2013 and 2023. Rapid-onset AKI was defined as KDIGO Stage 2 or higher within 24 h of ICU admission. Survival was analyzed using Kaplan-Meier and Cox regression methods to assess its association with 90-day mortality.
Twenty-four patients (26.4%) were classified as rapid-onset AKI. The median age, primary diagnosis, and preoperative serum creatinine levels were similar between groups. However, the rapid-onset AKI group had a preoperative lower left ventricular ejection fraction (42.5% vs. 60.0%, = 0.006), longer cardiopulmonary bypass time (332 vs. 245 min, = 0.009), and a longer duration of mechanical circulatory support (6.0 vs. 2.0 days, = 0.001). The success rate of weaning from mechanical circulatory support was lower (61.1% vs. 93.3%, = 0.002), and the 90-day cumulative survival probability was lower in the rapid-onset AKI group (29.1% [95% confidence interval (CI): 15.6-54.4 vs. 79.1% [95% CI: 69.9-89.4], < 0.001). Cox regression analysis confirmed an independent association between rapid-onset AKI and 90-day mortality (adjusted hazard ratio: 3.15, 95% CI: 1.38-7.19, = 0.006).
Rapid-onset AKI was significantly associated with increased 90-day mortality in patients with PCCS who required V-A ECMO.
心脏术后心源性休克（PCCS）是一种严重疾病，需要进行静脉-动脉体外膜肺氧合（VA-ECMO）治疗。尽管急性肾损伤（AKI）常使PCCS病情复杂化，但其对患者预后的具体影响仍不明确。本研究旨在评估AKI对90天死亡率的影响。
这项回顾性研究纳入了2013年至2023年间91例心脏手术后需要静脉-动脉体外膜肺氧合的术后心源性休克患者。快速发生的AKI定义为入住重症监护病房（ICU）24小时内达到KDIGO 2期或更高分期。采用Kaplan-Meier法和Cox回归分析评估生存率及其与90天死亡率的关联。
24例患者（26.4%）被归类为快速发生的AKI。两组患者的年龄中位数、主要诊断和术前血清肌酐水平相似。然而，快速发生AKI组术前左心室射血分数较低（42.5%对60.0%，P = 0.006），体外循环时间较长（332分钟对245分钟，P = 0.009），机械循环支持时间较长（6.0天对2.0天，P = 0.001）。机械循环支持撤机成功率较低（61.1%对93.3%，P = 0.002），快速发生AKI组90天累积生存概率较低（29.1%[95%置信区间（CI）：15.6 - 54.4]对79.1%[95%CI：69.9 - 89.4]，P < 0.001）。Cox回归分析证实快速发生的AKI与90天死亡率之间存在独立关联（调整后风险比：3.15，95%CI：1.38 - 7.19，P = 0.006）。
在需要V-A ECMO的PCCS患者中，快速发生的AKI与90天死亡率增加显著相关。
