Relation Between Transient or Persistent Acute Kidney Injury and Long-Term Mortality in Patients With Myocardial Infarction
Relation Between Transient or Persistent Acute Kidney Injury and Long-Term Mortality in Patients With Myocardial Infarction
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DOI：
10.1016/j.amjcard.2013.02.051
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发表时间：
2013-07-01
影响因子：
2.8
通讯作者：
Kim, Soo Wan
中科院分区：
文献类型：
--
作者：
Choi, Joon Seok;Kim, Young A.;Kim, Soo Wan
关于住院期间急性肾损伤(AKI)对心肌梗死(MI)后临床预后的影响的信息有限，一过性肾损伤(KI)对长期死亡率的影响尚未得到验证。我们回顾分析了2,289名被诊断为心肌梗塞的患者。根据出院时的血肌酐水平将AKI患者分为一过性KI组和持续性KI组。研究的终点是心肌梗死后3年的死亡率。我们纳入了2,110名患者，其中237名患者(11%)在住院期间发生了AKI。在237例患者中，154例(65%)为一过性KI，83例(35%)为持续性KI。多因素分析显示，年龄、左心室射血分数、入院时估计的肾小球滤过率和Killip分级与住院期间发生AKI显著相关。与非AKI患者相比，有一过性KI的AKI患者的3年死亡率的调整风险比为1.71(95%可信区间：1.08-2.70)，而有持续性KI的AKI患者的调整后风险比为2.21(95%可信区间：1.34-3.64)。总之，急性心肌梗死与经历心肌梗死并在住院期间存活的患者的死亡风险增加有关。虽然许多MU患者在出院时肾功能已完全恢复，但这些一过性KI患者在MI后死亡的风险也很大。(C)2013 Elsevier Inc.保留所有权利。
Limited information is available regarding the impact of acute kidney injury (AKI) during hospitalization on clinical outcomes after myocardial infarction (MI), and the effect of transient kidney injury (KI) on long-term mortality has not been validated. We retrospectively analyzed 2,289 patients diagnosed with MI. AKI patients were classified into a transient KI group and a persistent KI group based on serum creatinine levels at discharge. The end point of the study was 3-year mortality after MI. We included 2,110 patients of whom 237 patients (11%) developed AKI during hospitalization. Of these 237 patients, 154 (65%) had transient KI, and 83 (35%) had persistent KI. Multivariate analysis showed that age, left ventricular ejection fraction, estimated glomerular filtration rate on admission, and Killip class were significantly associated with developing AKI during hospitalization. The adjusted hazard ratios for 3-year mortality were 1.71 (95% confidence interval: 1.08-2.70) for AKI patients with transient KI and 2.21 (95% confidence interval: 1.34-3.64) for AKI patients with persistent KI, compared with no AKI. In conclusion, AKI was associated with an increased risk of death for patients who experienced MIs and survived during hospitalization. Although renal function had completely recovered in many MU patients at discharge, these transient KI patients are also at a great risk of death after MI. (C) 2013 Elsevier Inc. All rights reserved.