Abstract:

Objective To investigate the incidence, risk factors, and prognosis of acute kidney injury (AKI) for patients with acute cardiac dysfunction in the intensive care unit (ICU). Methods The clinical data of 219 patients who had diagnosed with acute cardiac dysfunction and treated in the ICU of Department of Emergency Medicine of Renji Hospital from April 2013 to July 2014. Laboratory tests were conducted, including tests for blood brain natriuretic peptide (BNP), serum creatinine, urinary protein, etc. Patients were divided into the AKI group and non-AKI group according to the KDIGO criteria. The clinical indexes, hospitalization time, and mortality of two groups were compared.  Multivariable logistic regression analysis was conducted to identify risk factors of AKI for patients with acute cardiac dysfunction. Results Among 219 patients with acute cardiac dysfunction, 81 (37%) of them developed AKI. The levels of baseline BNP, serum creatinine, and urine protein of the AKI group before the incidence of acute cardiac dysfunction were significantly higher than those of the non-AKI group [155.0(44.5-455.0) pg/mL vs 113.0(24.3-254.0) pg/mL, P=0.001; 89.2(59.2-149.0) μmol/L vs 68.4(51.0-112.0) μmol/L, P=0.006; and 20(10-50) mg/dL vs 10(0-20) mg/dL, P=0.001]. The incidences of infection and hypotension and ratio of administration of ACEI/ARB of the AKI group were significantly higher than those of the non-AKI group (P<0.05). The multivariate regression analysis showed that chronic kidney disease, infection, administration of ACEI/ARB, hypotension, high level of BNP, and increase of baseline urine protein were independent risk factors of the incidence of AKI of patients with acute cardiac dysfunction after factors such as gender, age, diabetes, hypertension, renal toxicity drugs, and baseline creatinine level were corrected. The ICU stay and hospital mortality of the AKI group were significantly higher than those of the non-AKI group [12(10-15)d vs 11(9-12)d and 24% vs 15%, respectively, both P<0.01]. Conclusion The incidence of AKI of patients with acute cardiac dysfunction is high. Chronic kidney disease, infection, administration of ACEI/ARB, hypotension, high level of BNP, and increase of baseline urine protein are independent risk factors of the incidence of AKI of patients with acute cardiac dysfunction. The prognosis of patients with acute cardiac dysfunction who develop AKI is poor. Understanding the incidence and risk factors of AKI might provide evidences for improving the prognosis of patients with acute cardiac dysfunction.

Key words: acute cardiac dysfunction, acute kidney injury, intensive care, risk factors, prognosis