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Abstract：
Acute kidney injury (AKI) is one of the most frequent and prognostic-relevant complications of cardiogenic shock (CS) complicating myocardial infarction (MI). Mechanical circulatory assist devices (MCS) like left ventricular Impella microaxial pump have increasingly been used in the last decade for stabilization of hemodynamics in those patients. Moreover, a protective effect of Impella on renal organ perfusion could recently be demonstrated. However, data identifying early risk predictors for developing AKI during Impella support in CS are rare. Data of hemodynamics and renal function from 50 Impella patients (January 2020 and February 2022) with MI-related CS (SCAI stage C), were retrospectively analyzed using e.g. multivariate logistic regression analysis as well as Kaplan-Meier curves and Cox regression analysis. 30 patients (60%) developed AKI. Central venous pressure as an indicator for venous congestion (OR 1.216, p = 0.02), GFR at admission indicating existing renal damage (OR 0.928, p = 0.002), and reduced central venous oxygen saturation (SvO2) as a marker for decreased tissue perfusion (OR 0.930, p = 0.029) were independently associated with developing an AKI. The 30-day mortality rate was significantly higher in patients with AKI stage 3 (Stage 1: 0%, Stage 2: 0%, Stage 3; 41.6%, p = 0.014) while AKI stage 3 (HR 0.095, p = 0.026) and norepinephrine dosage (HR 1.027, p = 0.008) were independent predictors for 30-day mortality. AKI as a complication of MI-related CS occurs frequently with a major impact on prognosis. Venous congestion, reduced tissue perfusion, and an already impaired renal function are independent predictors of AKI. Thus, timely diagnostics and a focused treatment of the identified factors could improve prognosis and outcome.
摘要：
急性肾损伤（AKI）是心源性休克（CS）并发心肌梗死（MI）的最常见且与预后相关的并发症之一。在过去的十年中，诸如左心室Impella微轴泵之类的机械循环辅助设备（MCS）已越来越多地用于稳定这些患者的血液动力学。此外，最近可以证明Impella对肾脏器官灌注的保护作用。然而,在CS的Impella支持期间，很少有数据确定发生AKI的早期风险预测因子。50例Impella患者（2020年1月和2022年2月）的血流动力学和肾功能数据与MI相关的CS（SCAI阶段C），使用多变量逻辑回归分析以及Kaplan-Meier曲线和Cox回归分析进行回顾性分析。30例(60%)患者发生AKI。中心静脉压作为静脉充血的指标（OR1.216，p=0.02），入院时GFR表明存在肾损害（OR0.928，p=0.002），中心静脉血氧饱和度(SvO2)降低作为组织灌注降低的标志(OR0.930,p=0.029)与AKI的发生独立相关.AKI3期患者的30天死亡率明显较高（1期：0％，第二阶段:0%,第三阶段；41.6%，p=0.014），而AKI阶段3（HR0.095，p=0.026）和去甲肾上腺素剂量（HR1.027，p=0.008）是30天死亡率的独立预测因子。AKI作为MI相关CS的并发症经常发生，对预后有重要影响。静脉充血,减少组织灌注，肾功能受损是AKI的独立预测因子。因此，及时诊断和对已确定因素的集中治疗可以改善预后和结局.
