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Can we predict acute kidney injury in patients admitted with acute coronary syndromes?
Session:
Posters 4 - Écran 2 - Doença Coronária
Speaker:
João André Ferreira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João André Ferreira; Sílvia Monteiro; Pedro Monteiro; Rui Baptista; Francisco Gonçalves; Lino Gonçalves
Abstract
<p>Background: Acute kidney injury (AKI) is a complex, potentially catastrophic disorder whose clinical manifestations range from mild increase in creatinin levels to serious anuria leading to emergent renal replacement therapy. There have been increasing reports stating the important prevalence of AKI in patients admitted with acute coronary syndromes (ACS). <br /> <br /> Purpose: To determine the incidence of AKI in patients admitted with ACS in a portuguese coronary care unit (CCU) and to study possible clinical predictors associated with AKI development. <br /> <br /> Methods: We analyzed data from all patients admitted with ACS in a portuguese CCU, between 2007 and 2016. AKI and its severity were defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were divided in 2 groups according to the development of AKI during hospital stay (AKI vs. no AKI). Groups were compared for potential demographic, clinical, treatment and outcome differences. <br /> <br /> Results: We obtained 4791 patients admitted for ACS, 1299 unstable anginas (27.1%), 2035 non-ST-elevation myocardial infarctions (42.5%) and 1457 ST-elevation myocardial infarctions (30.4%). AKI was observed in 1611 (33.6%). Regarding AKI severity patients were classified in stage 1 (24.8%, n=1189), stage 2 (3.1%, n=148) and stage 3 (5.7%, n=274). AKI group patients were older (72.31±11.1 vs. 65.05±12.9 years, p<0.001), more diabetic (39.4% vs. 28.1%, p<0.001), more hypertensive (82.8% vs. 74.3%, p<0.001) and had more significant coronary artery disease (88.9% vs. 78.6%, p<0.001). There was no significant difference regarding AKI after an invasive strategy (32.3% vs. 31.6%, p=0.685). Higher AKI stages were associated with higher peak troponin-I, peak C-reactive protein, peak glycemia and lower hemoglobin levels during hospital stay. AKI was associated with increased hospital stay (5.93±9.9 vs. 3.72±2.2 days, p<0.001) and elevated in-hospital (3.2% vs. 1.4%, p<0.001), 30-day (5.9% vs. 2.3%, p<0.001), 6-month (7.7% vs. 3.8%, p<0.001), 1-year (9.2% vs. 4.9%, p<0.001) and 5-year mortality (16.4% vs. 11.5%, p <0.001). After multivariate analysis we found that age greater than 65 years (OR 3.056, 95% CI 2.669-3.499, p<0.001), diabetes (OR 2.597, 95% CI 2.282-2.955, p<0.001), anaemia (OR 4.057, 95% CI 3.523-4.673), stress hyperglycemia at admission (OR 2.134, 95% CI 1.888-2.412, p<0.001), diuretic use (OR 2.035, 95% CI 1.743-2.376, p<0.001), catecholamines use (OR 5.369, 95% CI 3.739-7.708, p<0.001) and regular insulin use (OR 1.864, CI 95% 1.508-2.304, p<0.001) were independently associated with a greater risk of AKI. <br /> <br /> Conclusions: AKI complicates a large quantity of ACS hospital admissions. Its development during hospitalisation is associated with a greater short-term and long-term mortality. Patients that develop AKI tend to have more comorbidities, and AKI itself correlates with ACS severity.</p>
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