Acute kidney injury and renal function changes in cardiogenic shock

AIMS: To evaluate the prognostic role of acute kidney injury (AKI) and estimated glomerular filtration rate (eGFR) in patients with cardiogenic shock (CS). METHODS: All consecutive patients admitted for CS were retrospectively included. The association of AKI development within 48 h from admission with in-hospital mortality was evaluated. Predictors of AKI and the role of eGFR reassessment were also evaluated. RESULTS: A total of 313 patients with CS were included. AKI was independently associated with increased in-hospital mortality [adjusted odds ratio (OR) for AKI vs. no-AKI 3.38, 95% confidence interval (CI) 1.82-6.28, P < 0.001]. The risk of mortality progressively increased at increasing AKI stages ( P < 0.001). Higher eGFR was independently associated with a decreased risk of in-hospital mortality when considering either baseline values, 24-h values and 48-h values. The accuracy of 48-h eGFR in predicting in-hospital mortality [area under the curve (AUC) 0.789] was higher compared with 24-h eGFR (AUC 0.754) and baseline eGFR (AUC 0.686). At multivariable logistic regression analysis, chronic kidney disease (CKD) and central venous pressure (CVP) were associated with a higher likelihood of AKI, whereas higher mean arterial pressure (MAP) was associated with a lower likelihood. CONCLUSIONS: In patients with CS, AKI development within 48 h was independently associated with in-hospital mortality and the risk progressively increased at increasing AKI stages. An eGFR reassessment at 48 h had a higher accuracy for predicting mortality compared with eGFR values at admission and 24 h. Previous CKD, MAP and CVP were the predictors of AKI development.