■心源性休克与不良临床结局相关。缺乏前瞻性数据来检查心源性休克和肾功能不全患者的正性肌力疗法的有效性和安全性。
■本研究试图检查米力农与多巴酚丁胺相比对肾功能的治疗效果。
■在对DOREMI(米力农与多巴酚丁胺治疗心源性休克)试验的事后分析中,我们根据基线估计的肾小球滤过率(eGFR)60ml/min/1.73m2和急性肾损伤(AKI)进行分层后,对比了米力农与多巴酚丁胺的临床结局.主要结果是任何原因导致的院内死亡的复合结果,心脏骤停复苏,接受心脏移植或机械循环支持,非致死性心肌梗死,短暂性脑缺血发作或中风,或开始肾脏替代疗法。
■在78(45%)和124(65%)患者中观察到基线eGFR<60ml/min/1.73m2和AKI,分别。主要结局和任何原因死亡发生在99例(52%)和76例(40%)患者中,分别。与多巴酚丁胺相比,eGFR<60ml/min/1.73m2似乎没有调节米力农的治疗效果。相比之下,在主要结局(P交互作用=0.02)和死亡(P交互作用=0.04)方面,与多巴酚丁胺相比,米力农的治疗效果和AKI之间存在显著交互作用.与多巴酚丁胺相比,米力农的主要结局和死亡风险较低,但不是,AKI.
■在心源性休克需要正性肌力支持的患者中,基线肾功能不全和AKI很常见.与多巴酚丁胺相比,观察到AKI对米力农相对功效的调节作用,在发生AKI的患者中,与多巴酚丁胺相比,米力农的潜在临床益处减弱。
UNASSIGNED: Cardiogenic shock is associated with poor clinical outcomes. There is a paucity of prospective data examining the efficacy and safety of inotropic therapy in patients with cardiogenic shock and renal dysfunction.
UNASSIGNED: This study sought to examine the treatment effect of milrinone compared to dobutamine in relation to renal function.
UNASSIGNED: In this post hoc analysis of the DOREMI (Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock) trial, we examined clinical outcomes with milrinone compared to dobutamine after stratification based on baseline estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m2 and acute kidney injury (AKI). The primary outcome was the composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy.
UNASSIGNED: Baseline eGFR <60 ml/min/1.73 m2 and AKI were observed in 78 (45%) and 124 (65%) of patients, respectively. The primary outcome and death from any cause occurred in 99 (52%) and 76 (40%) patients, respectively. eGFR <60 ml/min/1.73 m2 did not appear to modulate the treatment effect of milrinone compared to dobutamine. In contrast, there was a significant interaction between the treatment effect of milrinone compared to dobutamine and AKI with respect to the primary outcome (P interaction = 0.02) and death (P interaction = 0.04). The interaction was characterized by lower risk of primary outcome and death with milrinone compared to dobutamine in patients without, but not with, AKI.
UNASSIGNED: In patients requiring inotropic support for cardiogenic shock, baseline renal dysfunction and AKI are common. A modulating effect of AKI on the relative efficacy of milrinone compared to dobutamine was observed, characterized by attenuation of a potential clinical benefit with milrinone compared to dobutamine in patients who develop AKI.