Abstract 12861: Associations between Acute Kidney Injury in the Acute Phase of Acute Heart Failure and the Outcomes; An Evaluation of Acute Kidney Injury on Admission and the Following Five Days
Backgrounds: The relationship between acute kidney injury (AKI) in the acute phase of acute heart failure (AHF) and the outcomes has not yet been reported.
Methods and Results: Six hundred twenty-five patients with AHF admitted to the intensive care unit were analyzed. No AKI occurred in 281 patients (no-AKI) during the first 5 days. The AKI patients were assigned to two groups based on the timing: AKI presenting upon admission (early-AKI; n=174), or AKI that occurred after admission from days 2 to days 5 (late-AKI; n=170). The early-AKI patients were also assigned to two groups: stable RIFLE class during the first 5 days (stable early-AKI; n=125), or step-up RIFLE class during the first 5 days (worsening early-AKI; n=49). The AKI patients were also grouped into another three groups based on most severe degree during the first 5 days: Class R (risk; n=214), Class I (injury; n=73), or Class F (failure; n=57). We evaluated the relationships between the timing and the degree of AKI, and outcomes (in-hospital mortality, any-cause death and HF events including readmission to the hospital for HF within 2 years). The results of the multivariate logistic regression model for in-hospital mortality found that the specific factors were worsening early-AKI (OR: 2.881; 95% CI: 1.007-8.243), late-AKI (OR: 3.192; 95% CI: 1.369-7.443), Class I (OR: 3.654; 95% CI: 1.424-9.377) and Class F (OR: 4.361; 95% CI: 1.653-11.506). The Kaplan-Meier survival curves showed that the any-cause death was significantly poorer in early-AKI than in late-AKI and no-AKI, to be significantly poorer in late-AKI than in no-AKI, and to be significantly poorer in worsening early-AKI than in stable early-AKI and late-AKI; furthermore, to be significantly poorer in the Class I than in the no-AKI and Class R, to be significantly poorer in Class F than in the no-AKI, Class R and I. The HF events were significantly more in early-AKI than in the no-AKI, to be more in worsening early-AKI than in late-AKI; moreover, to be significantly more in the Class F than in the no-AKI, Class R and I. There were significantly more Class I and F patients in worsening early-AKI.
Conclusions: The presence of AKI on admission, a worsening of the presence AKI, and severe AKI (Class I and F) are associated with a poorer prognosis for AHF patients.
- © 2012 by American Heart Association, Inc.