- •Patients with reduced initial 24-h UO had higher short-term mortality after STEMI.
- •Initial 24-h UO ≤1020 mL was an independent risk factor of short-term mortality.
- •Combination of initial 24-h UO with TRS improved outcomes predictive ability.
Our study aims to evaluate the prognostic value of initial 24-h urine output (UO) in patients with ST-segment elevation myocardial infarction (STEMI) admitted without cardiogenic shock and renal dysfunction, and to determine the additional risk stratification offered by adding initial 24-h UO to TIMI risk score (TRS).
Data from 7078 consecutive STEMI patients in a multi-center registry were retrospectively analyzed. Patients were divided into 4 groups according to initial 24-h UO quartiles. The primary endpoints were 7- and 30-day all-cause mortality.
Patients in the lowest UO quartile (≤1020 mL) had significantly higher 7- and 30-day all-cause mortality rates, cardiogenic shock, and major adverse cardiovascular events (MACE) than those in other groups (all P < 0.05). After multivariate adjustment, initial 24-h UO ≤1020 mL was independently associated with an increased risk in 7-day all-cause mortality (HR = 4.649, 95%CI 3.348–6.455) and 30-day all-cause mortality (HR = 3.775, 95%CI 2.891–4.931) as well as 7-day MACE (HR = 1.845, 95%CI 1.563–2.179) and 30-day MACE (HR = 1.818, 95%CI 1.553–2.127). Initial 24-h UO provided additional risk stratification across all TRS groups and improved the discriminatory ability of TRS with respect to 7-day all-cause mortality (c-statistic from 0.704 to 0.764) and 30-day all-cause mortality (c-statistic from 0.706 to 0.743).
Reduced initial 24-h UO (≤1020 mL) was associated with an increased risk in 7- and 30-day all-cause mortality and MACE in STEMI patients admitted without cardiogenic shock and renal dysfunction. The combination of initial 24-h UO and TRS improved short-term outcome prediction when compared to TRS alone, particularly in patients with initial 24-h UO ≤1020 mL.
Abbreviations:ACEI (angiotensin-converting enzyme inhibitors), AKI (acute kidney injury), AMI (acute myocardial infarction), ARB (angiotensin receptors blockers), CCB (calcium channel blocker), CIs (confidence intervals), CK-MB (creatine kinase-MB), CrCl (creatinine clearance), DBP (diastolic blood pressure), GFR (glomerular filtration rate), HRs (hazard ratios), MACE (major adverse cardiovascular events), MI (myocardial infarction), PCI (percutaneous coronary intervention), RAA (rennin angiotensin aldosterone), RIFLE (Risk, Injury, Failure, Loss, and End-Stage Renal Disease), SBP (systolic blood pressure), SCr (serum creatinine), STEMI (ST-segment elevation myocardial infarction), TnI (troponin I), TRS (TIMI risk score), UO (urine output)
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Published online: March 10, 2015
Accepted: March 4, 2015
Received in revised form: February 13, 2015
Received: September 8, 2014
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