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. 2024 Jul 30;14(1):17484.
doi: 10.1038/s41598-024-68376-w.

Early risk predictors of acute kidney injury and short-term survival during Impella support in cardiogenic shock

Nikolaos Patsalis  1 , Julian Kreutz  1 , Giorgos Chatzis  1 , Styliani Syntila  1 , Maryana Choukeir  1 , Bernhard Schieffer  1 , Birgit Markus  2
Affiliations

Early risk predictors of acute kidney injury and short-term survival during Impella support in cardiogenic shock

Nikolaos Patsalis et al. Sci Rep. .

Abstract

Acute kidney injury (AKI) is one of the most frequent and prognostic-relevant complications of cardiogenic shock (CS) complicating myocardial infarction (MI). Mechanical circulatory assist devices (MCS) like left ventricular Impella microaxial pump have increasingly been used in the last decade for stabilization of hemodynamics in those patients. Moreover, a protective effect of Impella on renal organ perfusion could recently be demonstrated. However, data identifying early risk predictors for developing AKI during Impella support in CS are rare. Data of hemodynamics and renal function from 50 Impella patients (January 2020 and February 2022) with MI-related CS (SCAI stage C), were retrospectively analyzed using e.g. multivariate logistic regression analysis as well as Kaplan-Meier curves and Cox regression analysis. 30 patients (60%) developed AKI. Central venous pressure as an indicator for venous congestion (OR 1.216, p = 0.02), GFR at admission indicating existing renal damage (OR 0.928, p = 0.002), and reduced central venous oxygen saturation (SvO2) as a marker for decreased tissue perfusion (OR 0.930, p = 0.029) were independently associated with developing an AKI. The 30-day mortality rate was significantly higher in patients with AKI stage 3 (Stage 1: 0%, Stage 2: 0%, Stage 3; 41.6%, p = 0.014) while AKI stage 3 (HR 0.095, p = 0.026) and norepinephrine dosage (HR 1.027, p = 0.008) were independent predictors for 30-day mortality. AKI as a complication of MI-related CS occurs frequently with a major impact on prognosis. Venous congestion, reduced tissue perfusion, and an already impaired renal function are independent predictors of AKI. Thus, timely diagnostics and a focused treatment of the identified factors could improve prognosis and outcome.

Keywords: Acute kidney injury (AKI); Cardiogenic shock; Left ventricular Impella; Predictors of AKI.

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Conflict of interest statement

B.M. received research funding from Abiomed; J.K., G.C., B.S., and B.M. receive speaker’s honoraria from Abiomed; no other of the remaining authors declared any disclosures.

Figures

Figure 1
Figure 1
Study cohort.
Figure 2
Figure 2
30-Day cumulative survival. Red: patients with acute kidney injury (AKI), green: patients without AKI (Non-AKI) (Kaplan–Meyer analysis).
Figure 3
Figure 3
30-Day cumulative survival. Orange: no kidney injury, blue: AKI stages 1 and 2, purple: AKI stage 3 (Kaplan–Meyer analysis).
See this image and copyright information in PMC

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