Abstract：
OBJECTIVE: To assess the stage of acute kidney injury (AKI), as an index of organ perfusion, combined with shock severity, measured by the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification, to stratify the risk of mortality in patients diagnosed with cardiogenic shock (CS) and supported with venoarterial extracorporeal membrane oxygenation (VA ECMO).
UNASSIGNED: From January 2018 to December 2020, consecutive adult patients diagnosed with CS and received VA ECMO were retrospectively evaluated. The highest AKI stage within 48 h after ECMO initiation was assessed using the Kidney Disease: Improving Global Outcomes criteria. We included 216 patients with a mean age of 58.8 years and 31.0% were females. 88.4% of patients received ECMO for postcardiotomy, while 11.6% for medical CS. The total in-hospital mortality was 53.2%. AKI occurred in 182 (84.3%) patients receiving ECMO for CS. AKI stage 0, 1, 2, and 3 were present in 15.7%, 17.6%, 18.1%, and 48.6% of patients with in-hospital mortality of 26.5%, 26.3%, 61.5%, and 68.6%, respectively (P < 0.001). The AKI stage (P < 0.001), SCAI shock stage before ECMO (P = 0.008), and NYHA ≥ Class III on admission (P = 0.044) were independent predictors of in-hospital mortality. The area under the receiver operating characteristic curve of 0.754 (95% confidence interval: 0.690 to 0.811) for AKI stage combined with SCAI shock stage was better than those for AKI stage (0.676), SCAI shock stage (0.657), serum lactate level (0.682), SOFA score (0.644), SVAE score (0.582), and VIS score (0.530) prior to ECMO.
CONCLUSIONS: In this single-center CS population who received VA ECMO for circulatory support, predominantly postcardiotomy cases, AKI occurred in 84.3% of the patients. AKI stage, as an index of organ perfusion combined with shock severity measured by the SCAI shock classification, demonstrates a good correlation with in-hospital mortality.
UNASSIGNED: From January 2018 to December 2020, consecutive adult patients diagnosed with CS and received VA ECMO were retrospectively evaluated. The highest AKI stage within 48 h after ECMO initiation was assessed using the Kidney Disease: Improving Global Outcomes criteria. We included 216 patients with a mean age of 58.8 years and 31.0% were females. 88.4% of patients received ECMO for postcardiotomy, while 11.6% for medical CS. The total in-hospital mortality was 53.2%. AKI occurred in 182 (84.3%) patients receiving ECMO for CS. AKI stage 0, 1, 2, and 3 were present in 15.7%, 17.6%, 18.1%, and 48.6% of patients with in-hospital mortality of 26.5%, 26.3%, 61.5%, and 68.6%, respectively (P < 0.001). The AKI stage (P < 0.001), SCAI shock stage before ECMO (P = 0.008), and NYHA ≥ Class III on admission (P = 0.044) were independent predictors of in-hospital mortality. The area under the receiver operating characteristic curve of 0.754 (95% confidence interval: 0.690 to 0.811) for AKI stage combined with SCAI shock stage was better than those for AKI stage (0.676), SCAI shock stage (0.657), serum lactate level (0.682), SOFA score (0.644), SVAE score (0.582), and VIS score (0.530) prior to ECMO.
CONCLUSIONS: In this single-center CS population who received VA ECMO for circulatory support, predominantly postcardiotomy cases, AKI occurred in 84.3% of the patients. AKI stage, as an index of organ perfusion combined with shock severity measured by the SCAI shock classification, demonstrates a good correlation with in-hospital mortality.
摘要：
目的：评估急性肾损伤（AKI）的分期，作为器官灌注的指标，结合休克的严重程度，由心血管造影和干预协会（SCAI）休克阶段分类测量，对诊断为心源性休克（CS）并接受静脉动脉体外膜氧合（VAECMO）支持的患者的死亡风险进行分层。
■从2018年1月至2020年12月，对诊断为CS并接受VAECMO的连续成年患者进行了回顾性评估。使用肾脏疾病：改善全球结果标准评估ECMO开始后48小时内的最高AKI阶段。我们纳入了216例患者，平均年龄为58.8岁，女性占31.0％。88.4%的患者在心脏切开术后接受了ECMO，而医疗CS为11.6%。住院总死亡率为53.2%。182例(84.3%)因CS接受ECMO治疗的患者发生AKI。AKI阶段0、1、2和3占15.7%，17.6%,18.1%,48.6%的患者住院死亡率为26.5%，26.3%,61.5%,和68.6%，分别(P<0.001)。AKI分期(P<0.001),ECMO前SCAI休克阶段（P=0.008），入院时NYHA≥III级(P=0.044)是院内死亡率的独立预测因子.AKI阶段合并SCAI休克阶段的受试者工作特征曲线下面积为0.754（95％置信区间：0.690至0.811），优于AKI阶段（0.676）。SCAI冲击阶段（0.657），血清乳酸水平（0.682），SOFA评分（0.644），SVAE评分（0.582），和ECMO之前的VIS评分（0.530）。
结论：在接受VAECMO循环支持的单中心CS人群中，主要是心脏切开术后病例，84.3%的患者发生AKI。AKI阶段,作为通过SCAI休克分类测量的器官灌注与休克严重程度相结合的指标，与住院死亡率有良好的相关性。
■从2018年1月至2020年12月，对诊断为CS并接受VAECMO的连续成年患者进行了回顾性评估。使用肾脏疾病：改善全球结果标准评估ECMO开始后48小时内的最高AKI阶段。我们纳入了216例患者，平均年龄为58.8岁，女性占31.0％。88.4%的患者在心脏切开术后接受了ECMO，而医疗CS为11.6%。住院总死亡率为53.2%。182例(84.3%)因CS接受ECMO治疗的患者发生AKI。AKI阶段0、1、2和3占15.7%，17.6%,18.1%,48.6%的患者住院死亡率为26.5%，26.3%,61.5%,和68.6%，分别(P<0.001)。AKI分期(P<0.001),ECMO前SCAI休克阶段（P=0.008），入院时NYHA≥III级(P=0.044)是院内死亡率的独立预测因子.AKI阶段合并SCAI休克阶段的受试者工作特征曲线下面积为0.754（95％置信区间：0.690至0.811），优于AKI阶段（0.676）。SCAI冲击阶段（0.657），血清乳酸水平（0.682），SOFA评分（0.644），SVAE评分（0.582），和ECMO之前的VIS评分（0.530）。
结论：在接受VAECMO循环支持的单中心CS人群中，主要是心脏切开术后病例，84.3%的患者发生AKI。AKI阶段,作为通过SCAI休克分类测量的器官灌注与休克严重程度相结合的指标，与住院死亡率有良好的相关性。
