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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Acute kidney injury and cardiogenic shock severity for mortality risk stratification in patients supported with VA
Chenglong Li1, Yiwen Wang1, Xiaomeng Wang1
1Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Acute kidney injury (AKI) stage and Society for Cardiovascular Angiography and Interventions (SCAI) shock stage are key predictors of mortality in cardiogenic shock (CS) patients on venoarterial extracorporeal membrane oxygenation (VA ECMO). Combining these markers improves mortality risk stratification.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) is a severe condition requiring advanced circulatory support.
- Venoarterial extracorporeal membrane oxygenation (VA ECMO) is used for CS patients but carries significant mortality risks.
- Acute kidney injury (AKI) is a common complication in CS, potentially indicating poor organ perfusion.
Purpose of the Study:
- To evaluate the prognostic value of AKI stage and Society for Cardiovascular Angiography and Interventions (SCAI) shock stage in CS patients treated with VA ECMO.
- To determine if combining AKI and SCAI shock stages improves mortality risk stratification.
- To assess AKI as an index of organ perfusion in the context of CS and VA ECMO support.
Main Methods:
- Retrospective analysis of 216 adult CS patients receiving VA ECMO between January 2018 and December 2020.
- Assessment of the highest AKI stage within 48 hours of VA ECMO initiation using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
- Stratification of patients based on AKI and SCAI shock stages to analyze in-hospital mortality rates.
Main Results:
- AKI occurred in 84.3% of CS patients on VA ECMO.
- Higher AKI stages (especially stage 3) and higher SCAI shock stages were significantly associated with increased in-hospital mortality (P < 0.001).
- The combined AKI and SCAI shock stages demonstrated a superior area under the receiver operating characteristic curve (0.754) for predicting mortality compared to individual markers or other scores.
Conclusions:
- AKI is highly prevalent in CS patients requiring VA ECMO.
- AKI stage, reflecting organ perfusion, and SCAI shock stage are independent predictors of in-hospital mortality.
- The combination of AKI stage and SCAI shock stage provides a robust tool for stratifying mortality risk in this patient population.
Aims:
To assess the stage of acute kidney injury (AKI), as an index of organ perfusion, combined with shock severity, measured by the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification, to stratify the risk of mortality in patients diagnosed with cardiogenic shock (CS) and supported with venoarterial extracorporeal membrane oxygenation (VA ECMO).
Methods Ans Results:
From January 2018 to December 2020, consecutive adult patients diagnosed with CS and received VA ECMO were retrospectively evaluated. The highest AKI stage within 48 h after ECMO initiation was assessed using the Kidney Disease: Improving Global Outcomes criteria. We included 216 patients with a mean age of 58.8 years and 31.0% were females. 88.4% of patients received ECMO for postcardiotomy, while 11.6% for medical CS. The total in-hospital mortality was 53.2%. AKI occurred in 182 (84.3%) patients receiving ECMO for CS. AKI stage 0, 1, 2, and 3 were present in 15.7%, 17.6%, 18.1%, and 48.6% of patients with in-hospital mortality of 26.5%, 26.3%, 61.5%, and 68.6%, respectively (P < 0.001). The AKI stage (P < 0.001), SCAI shock stage before ECMO (P = 0.008), and NYHA ≥ Class III on admission (P = 0.044) were independent predictors of in-hospital mortality. The area under the receiver operating characteristic curve of 0.754 (95% confidence interval: 0.690 to 0.811) for AKI stage combined with SCAI shock stage was better than those for AKI stage (0.676), SCAI shock stage (0.657), serum lactate level (0.682), SOFA score (0.644), SVAE score (0.582), and VIS score (0.530) prior to ECMO.
Conclusions:
In this single-center CS population who received VA ECMO for circulatory support, predominantly postcardiotomy cases, AKI occurred in 84.3% of the patients. AKI stage, as an index of organ perfusion combined with shock severity measured by the SCAI shock classification, demonstrates a good correlation with in-hospital mortality.
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