Highlights
- •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.
Abstract
Objectives
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).
Methods
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.
Results
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).
Conclusion
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.
Keywords
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)To read this article in full you will need to make a payment
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References
- TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy.Circulation. 2000; 102: 2031-2037
- 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2013; 127: e362-e425
- Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction.Am. Heart J. 2005; 150: 330-337
- Update on mechanisms of ischemic acute kidney injury.J. Am. Soc. Nephrol. 2006; 17: 1503-1520
- Acute kidney injury.Lancet. 2012; 380: 756-766
- Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry.JACC Cardiovasc. Interv. 2014; 7: 1-9
- Incidence and mortality of acute kidney injury after myocardial infarction: a comparison between KDIGO and RIFLE criteria.PLoS One. 2013; 8: e69998
- Renal impairment according to acute kidney injury network criteria among ST elevation myocardial infarction patients undergoing primary percutaneous intervention: a retrospective observational study.Clin. Res. Cardiol. 2014;
- Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission.Crit. Care Med. 2010; 38: 438-444
- Impact of acute kidney injury on clinical outcomes after ST elevation acute myocardial infarction.Yonsei Med. J. 2011; 52: 603-609
- Renal function at hospital admission and mortality due to acute kidney injury after myocardial infarction.PLoS One. 2012; 7: e35496
- Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.Crit. Care. 2004; 8: R204-R212
- Prognostic significance of acute kidney injury after reperfused ST-elevation myocardial infarction: synergistic acceleration of renal dysfunction and left ventricular remodeling.J. Card. Fail. 2010; 16: 381-389
- Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality.J. Am. Coll. Cardiol. 2003; 42: 1535-1543
- Normotensive ischemic acute renal failure.N. Engl. J. Med. 2007; 357: 797-805
- Reversible anuric acute kidney injury secondary to acute renal autoregulatory dysfunction.Ren. Fail. 2014; 36: 111-113
- The prognostic value of serum creatinine on admission in fibrinolytic-eligible patients with acute myocardial infarction.J. Thromb. Thrombolysis. 2003; 16: 167-174
- Baseline hemoglobin concentration and creatinine clearance composite laboratory index improves risk stratification in ST-elevation myocardial infarction.Am. Heart J. 2009; 157: 517-524
- Renal dysfunction on admission, worsening renal function, and severity of acute kidney injury predict 2-year mortality in patients with acute myocardial infarction.Circ. J. 2013; 77: 217-223
- Reperfusion in patients with renal dysfunction after presentation with ST-segment elevation or left bundle branch block: GRACE (Global Registry of Acute Coronary Events).JACC Cardiovasc. Interv. 2009; 2: 26-33
- Critical care: estimating renal function in the ICU: even more challenging.Nat. Rev. Nephrol. 2011; 7: 549-550
- Measuring renal function in critically ill patients: tools and strategies for assessing glomerular filtration rate.Curr. Opin. Crit. Care. 2013; 19: 560-566
- A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients.Crit. Care. 2012; 16: R200
- Urinary nitrate might be an early biomarker for pediatric acute kidney injury in the emergency department.Pediatr. Res. 2011; 70: 203-207
- Defining urine output criterion for acute kidney injury in critically ill patients.Nephrol. Dial. Transplant. 2011; 26: 509-515
- Oliguria is an early predictor of higher mortality in critically ill patients.Kidney Int. 2011; 80: 760-767
- Oliguria as predictive biomarker of acute kidney injury in critically ill patients.Crit. Care. 2011; 15: R172
- Additional role of urine output criterion in defining acute kidney injury.Nephrol. Dial. Transplant. 2012; 27: 161-165
- Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO investigators. Global utilization of streptokinase and tissue-plasminogen activator for occluded coronary arteries.Am. Heart J. 1999; 138: 21-31
- Prognostic value of neurohumoral activation in patients with an acute myocardial infarction: effect of captopril.J. Am. Coll. Cardiol. 1994; 24: 583-591
- Clinical and hemodynamic correlates of elevated plasma arginine vasopressin after acute myocardial infarction.Am. J. Cardiol. 1987; 60: 1178-1180
- Prognostic value of circulating levels of endothelin-1 in patients after acute myocardial infarction undergoing primary coronary angioplasty.Chest. 2005; 127: 1491-1497
- Cardiorenal syndrome.J. Am. Coll. Cardiol. 2008; 52: 1527-1539
- Analysis of biomarkers for risk of acute kidney injury after primary angioplasty for acute ST-segment elevation myocardial infarction: results of the HORIZONS-AMI trial.Catheter. Cardiovasc. Interv. 2014;
- Urine output on ICU entry is associated with hospital mortality in unselected critically ill patients.J. Nephrol. 2014; 27: 65-71
Article info
Publication history
Published online: March 10, 2015
Accepted:
March 4,
2015
Received in revised form:
February 13,
2015
Received:
September 8,
2014
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.