Prognostic Impact of Acute Kidney Injury in Patients With Acute Decompensated Heart Failure
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概要
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Background: The relationship between acute kidney injury (AKI) in the acute phase of acute decompensated heart failure (ADHF) and patient outcome has not yet been reported. Methods and Results: Data for 625 patients with ADHF admitted to the intensive care unit were analyzed. No AKI occurred in 281 patients (no AKI) during the first 5 days. The AKI patients were assigned to 3 groups based on the timing: AKI present on admission and stable risk, injury, failure, loss, and endstage (RIFLE) class (stable early AKI; n=125), stepped-up RIFLE class (worsening early AKI; n=49), or AKI that occurred after admission (late AKI; n=170). The AKI patients were grouped into another 3 groups based on severity: class R (risk; n=214), class I (injury; n=73), or class F (failure; n=57). A multivariate logistic regression model found class I, class F, late AKI and worsening early AKI to be independently associated with in-hospital mortality. Kaplan-Meier survival curves showed that the survival rate in any-cause death during 2 years was significantly lower in class I, class F and the worsening early-AKI group, and there were significantly more HF events in class F and the worsening early-AKI group. There were significantly more class I and class F patients in the worsening early-AKI group. Conclusions: The presence of AKI on admission, worsening of AKI, and severe AKI (class I or class F) are associated with a poorer prognosis for ADHF patients. (Circ J 2013; 77: 687–696)
著者
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Shinada Takuro
Division Of Intensive Care Unit Chiba Hokusoh Hospital Nippon Medical School
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Tomita Kazunori
Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
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Kobayashi Nobuaki
Division Of Intensive Care Unit Chiba Hokusoh Hospital Nippon Medical School
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Mizuno Kyoichi
Department Of 1st Internal Medicine Nippon Medical School
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Shirakabe Akihiro
Division Of Intensive Care Unit Chiba Hokusoh Hospital
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Asai Kuniya
Department Of Cardiology Nippon Medical School
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Tsurumi Masafumi
Division Of Cardiology Department Of Medicine Nippon Medical School
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Hata Noritake
Division Of Intensive Care Unit Chiba Hokusoh Hospital Nippon Medical School
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Yokoyama Shinya
Division Of Intensive Care Unit Chiba Hokusoh Hospital Nippon Medical School
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Tomita Kazunori
Division Of Cardiology Hepatology Geriatrics And Integrated Medicine Department Of Internal Medicine Graduate School Of Medicine Nippon Medical School
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Yamamoto Yoshiya
Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
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Matsushita Masato
Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
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Tsurumi Masafumi
Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
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Okazaki Hirokake
Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
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Kobayashi Nobuaki
Division of Cardiology, Shizuoka Medical Center
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