Frequency and prognostic impact of acute kidney injury in patients with acute pulmonary embolism. Data from the RIETE registry

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:291

Article

Murgier, Martin¹  Darmon, Michael¹  Zeni, Fabrice¹  Valle, Reina⁶  Del Toro, Jorge⁷  Llamas, Pilar⁸  Mazzolai, Lucia⁹  Villalobos, Aurora¹⁰  Monreal, Manuel¹¹  Bertoletti, Laurent^2,3,4,5 

[1] St Etienne Univ Hosp, Hop Nord, Med Surg Intens Care Unit, Ave Albert Raimond, F-42270 St Etienne, France

[2] St Etienne Univ Hosp, Dept Vasc & Therapeut Med, Ave Albert Raimond, St Priest En Jarez, France

[3] INSERM, CIC1408, St Etienne, France

[4] UMR 1059, St Etienne, France

[5] INNOVTE, St Etienne, France

[6] Hosp Sierrallana, Dept Internal Med, Santander, Spain

[7] Hosp Gen Univ Gregorio Maranon, Dept Internal Med, Madrid, Spain

[8] Hosp Univ Fdn Jimenez Diaz, Dept Haematol, Madrid, Spain

[9] Univ Lausanne, CHUV, Dept Heart & Vessel, Div Angiol, Lausanne, Switzerland

[10] Hosp Reg Univ Malaga, Dept Internal Med, Malaga, Spain

[11] Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Barcelona, Spain

关键词: Pulmonary embolism;    Acute kidney injury;    Bleeding;    Risk;    Biomarkers;    Mortality;   

DOI  :  10.1016/j.ijcard.2019.04.083

来源: Elsevier

【 摘 要 】

Rationale: Acute kidney injury (AKI) is associated with a poor outcome. Although pulmonary embolism(PE) may promote AKI through renal congestion and/or hemodynamic instability, its frequency and influence on outcome in patients with acute PE have been poorly studied. Methods: The frequency of AKI (defined according to the Kidney Disease: Improving Global Outcomes definition) at baseline and its influence on the 30-day mortality was evaluated in patients with acute PE from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. We used multivariate analysis to assess whether the presence of AKI influenced the risk for 30-day death. Results: The study included 21,131 patients, of whom 6222 (29.5%) had AKI at baseline: 4385 patients (21%) in stage 1, 1385 (6.5%) in stage 2 and 452 (2%) in stage 3. The proportion of patients with high-risk PE in those with no AKI, AKI stage 1, AKI stage 2 or AKI stage 3 was: 2.8%, 5.3%, 8.8% and 12%, respectively (p < 0.001). After 30 days, 1236 patients (5.9%) died. Overall mortality was 4% in patients with no AKI, 8.4% in AKI stage 1, 14% in AKI stage 2 and 17% in AKI stage 3 (all p < 0.001). AKI was independently associated with an increased risk of all-cause death at 30 days (odds ratio = 1.25; 95% CI: 1.02-1.54). Conclusions: One in every 3-4 patients with acute PE had AKI at baseline. The presence of AKI independently predicted 30-day mortality. This study suggests that AKI may deserve to be evaluated as a prognostic factor in patients with acute PE. (C) 2019 Elsevier B.V. All rights reserved.

【 授权许可】

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