Definition of acute kidney injury impacts prevalence and prognosis in ACS patients undergoing coronary angiography.
Acute Coronary Syndrome
/ diagnostic imaging
Acute Kidney Injury
/ chemically induced
Aged
Aged, 80 and over
Biomarkers
/ blood
Contrast Media
/ adverse effects
Coronary Angiography
/ adverse effects
Creatinine
/ blood
Female
Germany
/ epidemiology
Glomerular Filtration Rate
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prospective Studies
Registries
Risk Assessment
Risk Factors
Terminology as Topic
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
15 04 2021
15 04 2021
Historique:
received:
05
01
2021
accepted:
30
03
2021
entrez:
16
4
2021
pubmed:
17
4
2021
medline:
5
10
2021
Statut:
epublish
Résumé
Development of acute kidney injury (AKI) in invasively managed patients with acute coronary syndrome (ACS) is associated with a markedly increased mortality risk. Different definitions of AKI are in use, leading to varying prevalence and outcome measurements. The aim of the present study is to analyze an ACS population undergoing coronary angiography for differences in AKI prevalence and outcome using four established AKI definitions. 944 patients (30% female) were enrolled in a prospective registry between 2003 and 2005 with 6-month all-cause mortality as outcome measure. Four established AKI definitions were used: an increase in serum creatinine (sCR) ≥ 1.5 fold, ≥ 0.3 mg/dl, and ≥ 0.5 mg/dl and a decrease in eGFR > 25% from baseline (AKIN 1, AKIN 2, CIN, and RIFLE definition groups, respectively). AKI rates varied widely between the different groups. Using the CIN definition, AKI frequency was lowest (4.4%), whereas it was highest if the RIFLE definition was applied (13.2%). AKIN 2 displayed a twofold higher AKI prevalence compared with AKIN 1 (10.2% vs. 5.3% (p < 0.001)). AKI was a strong risk factor for mid-term mortality, with distinctive variability between the definitions. The lowest mortality risk was found in the RIFLE group (HR 6.0; 95% CI 3.7-10.0; p < 0.001), whereas CIN revealed the highest risk (HR 16.7; 95% CI 9.9-28.1; p < 0.001). Prevalence and outcome in ACS patients varied considerably depending on the AKI definition applied. To define patients with highest renal function-associated mortality risk, use of the CIN definition seems to have the highest prognostic relevance.
Sections du résumé
BACKGROUND
Development of acute kidney injury (AKI) in invasively managed patients with acute coronary syndrome (ACS) is associated with a markedly increased mortality risk. Different definitions of AKI are in use, leading to varying prevalence and outcome measurements. The aim of the present study is to analyze an ACS population undergoing coronary angiography for differences in AKI prevalence and outcome using four established AKI definitions.
METHODS
944 patients (30% female) were enrolled in a prospective registry between 2003 and 2005 with 6-month all-cause mortality as outcome measure. Four established AKI definitions were used: an increase in serum creatinine (sCR) ≥ 1.5 fold, ≥ 0.3 mg/dl, and ≥ 0.5 mg/dl and a decrease in eGFR > 25% from baseline (AKIN 1, AKIN 2, CIN, and RIFLE definition groups, respectively).
RESULTS
AKI rates varied widely between the different groups. Using the CIN definition, AKI frequency was lowest (4.4%), whereas it was highest if the RIFLE definition was applied (13.2%). AKIN 2 displayed a twofold higher AKI prevalence compared with AKIN 1 (10.2% vs. 5.3% (p < 0.001)). AKI was a strong risk factor for mid-term mortality, with distinctive variability between the definitions. The lowest mortality risk was found in the RIFLE group (HR 6.0; 95% CI 3.7-10.0; p < 0.001), whereas CIN revealed the highest risk (HR 16.7; 95% CI 9.9-28.1; p < 0.001).
CONCLUSION
Prevalence and outcome in ACS patients varied considerably depending on the AKI definition applied. To define patients with highest renal function-associated mortality risk, use of the CIN definition seems to have the highest prognostic relevance.
Identifiants
pubmed: 33858335
doi: 10.1186/s12872-021-01985-9
pii: 10.1186/s12872-021-01985-9
pmc: PMC8051101
doi:
Substances chimiques
Biomarkers
0
Contrast Media
0
Creatinine
AYI8EX34EU
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
183Références
BMC Nephrol. 2018 Dec 22;19(1):374
pubmed: 30577763
Scand J Clin Lab Invest. 2014 Mar;74(2):81-8
pubmed: 24304491
Am Heart J. 2011 Jul;162(1):81-8
pubmed: 21742093
Interv Cardiol. 2016 Oct;11(2):98-104
pubmed: 29588714
Eur Radiol. 2018 Jul;28(7):2845-2855
pubmed: 29426991
Nat Rev Nephrol. 2017 Mar;13(3):169-180
pubmed: 28138128
Heart. 2018 May;104(9):767-772
pubmed: 29092921
Nephrol Dial Transplant. 2012 Dec;27(12):4263-72
pubmed: 23045432
Crit Care. 2007;11(2):R31
pubmed: 17331245
ScientificWorldJournal. 2014;2014:823169
pubmed: 25525625
Am J Cardiol. 2014 Aug 1;114(3):362-8
pubmed: 24927973
Am J Cardiol. 2015 Aug 1;116(3):426-30
pubmed: 26026866
J Am Soc Nephrol. 2017 Feb;28(2):653-659
pubmed: 27688297
Circulation. 2010 Jan 26;121(3):357-65
pubmed: 20065168
JACC Cardiovasc Interv. 2014 Jan;7(1):1-9
pubmed: 24456715
Angiology. 2015 Jul;66(6):519-24
pubmed: 25005762
Arch Intern Med. 2012 Feb 13;172(3):246-53
pubmed: 22332157
Eur Heart J Acute Cardiovasc Care. 2018 Dec;7(8):710-722
pubmed: 29064276
Circulation. 2002 May 14;105(19):2259-64
pubmed: 12010907
J Am Coll Cardiol. 2004 Nov 2;44(9):1780-5
pubmed: 15519007
Nephrology (Carlton). 2018 Mar;23(3):237-246
pubmed: 27990707
Crit Care. 2013 Feb 04;17(1):205
pubmed: 23394215
Am Heart J. 2011 May;161(5):963-71
pubmed: 21570530
Catheter Cardiovasc Interv. 2013 Nov 15;82(6):888-97
pubmed: 23362013
Nephrol Dial Transplant. 2011 Feb;26(2):399-401
pubmed: 20956809
Catheter Cardiovasc Interv. 2013 Nov 15;82(6):878-85
pubmed: 23703775
Circ Cardiovasc Interv. 2015 Aug;8(8):e002475
pubmed: 26198286
Crit Care. 2004 Aug;8(4):R204-12
pubmed: 15312219