One-Year Survival for Developing Acute Kidney Injury in Adult Patients with AMI Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Wan Chen; Mingyu Pei; Chunxia Chen; Bo Wang; Lei Shi; Guozheng Qiu; Wenlong Duan; Shengxin Chen; Qiao Wei; Xi Zeng; Huifeng Pang; Yanlin Wei; Ruihua Wu; Ruikai Zhu; Qingwei Ji; Liwen Lyu

doi:10.2147/IJGM.S427999

One-Year Survival for Developing Acute Kidney Injury in Adult Patients with AMI Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Int J Gen Med. 2023 Oct 5:16:4537-4548. doi: 10.2147/IJGM.S427999. eCollection 2023.

Authors

Wan Chen^#¹, Mingyu Pei^#¹, Chunxia Chen^#², Bo Wang^#¹, Lei Shi^#¹, Guozheng Qiu¹, Wenlong Duan¹, Shengxin Chen¹, Qiao Wei¹, Xi Zeng¹, Huifeng Pang¹, Yanlin Wei¹, Ruihua Wu¹, Ruikai Zhu¹, Qingwei Ji³, Liwen Lyu¹

Affiliations

¹ Department of Emergency, the People's Hospital of Guangxi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guang Xi Academy of Medical Sciences, Nanning, People's Republic of China.
² Department of Pharmacy, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China.
³ Department of Cardiovascular Medicine, The People's Hospital of Guang Xi Zhuang Autonomous Region& Research Center of Cardiovascular Disease, Guangxi Academy of Medical Sciences Nanning, Nanning, People's Republic of China.

^# Contributed equally.

Abstract

Objective: The incidence of cardiogenic shock cases treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been on the rise. Acute kidney injury (AKI) is a significant complication of cardiogenic shock and a frequent serious complication in patients requiring ECMO-supported therapy. AKI is strongly associated with unfavorable patient prognosis. However, there is a paucity of data on the influence of AKI on the prognosis of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) who are receiving ECMO support, particularly with regard to long-term outcomes.

Methods: This retrospective observational study included 103 patients in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2017 and June 2022. AKI was defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Cox regression and logistic regression were used to identify risk factors.

Results: In this study, the incidence of AKI was 63.11%, with AKI stage 1, 2, and 3 accounting for 21.36%, 12.62%, and 29.13%, respectively. Patients with severe AKI had significantly higher in-hospital mortality (43.33% vs 27.40%, P < 0.001), 30-day mortality (60.00% vs 31.51%, P = 0.001), and 1-year mortality (63.67% vs 34.25%, P<0.001) than those without severe AKI. Furthermore, severe AKI significantly increased the risk of one-year mortality (HR 10.816, CI 3.118-37.512, P<0.001). Baseline serum creatinine, baseline platelet, and active cardiopulmonary resuscitation were independent predictors of one-year mortality. In addition, baseline white blood cell count, baseline aspartate aminotransferase, baseline alanine aminotransferase (ALT), baseline serum creatinine, preoperative lactate, and postoperative mean arterial pressure were independent risk factors of severe AKI during hospitalization.

Conclusion: In patients with AMI-CS receiving ECMO support, AKI is highly prevalent. Development of severe AKI significantly increased the risk of one-year mortality.

Keywords: acute kidney injury; extracorporeal membrane oxygenation; prognosis; risk factors.

Grants and funding

This study was supported by the National Natural Science Foundation of China (81960246, 81701089 and 82260258), the Guangxi Natural Science Foundation (2020GXNSFAA238003 and 2017GXNSFBA198010), the Guangxi Medical and Health Appropriate Technology Research and Development Project (S2020076, S2020080), the Science Research and Technology Development Program of Guangxi (2017AB45111), Guangxi Science and Technology Program (AB17292091), Specific Research Project of Guangxi for Research Bases and Talents (GKAD17129026) and Guangxi Science and Technology Specialized Project (GKG14124003-9).