Georg Fuernau1, Christian Poenisch2, Ingo Eitel3, Daniel Denks2, Suzanne de Waha4, Janine Pöss3, Gunnar H Heine5, Steffen Desch3, Gerhard Schuler2, Volker Adams2, Karl Werdan6, Uwe Zeymer7, Holger Thiele3. 1. Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany. Electronic address: georg.fuernau@medizin.uni-leipzig.de. 2. Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany. 3. Department of Internal Medicine II, University Heart Center Lübeck, Lübeck, Germany. 4. Department of Cardiology/Angiology, Bad Segeberg Heart Center, Bad Segeberg, Germany. 5. Internal Medicine IV - Nephrology and Hypertension, Saarland University, Homburg, Germany. 6. Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany. 7. Medizinische Klinik B, Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Abstract
BACKGROUND: In cardiogenic shock (CS) renal dysfunction is an important parameter of inadequate end-organ perfusion and an independent predictor of adverse outcome. Early detection of renal dysfunction is therefore important, and novel biomarkers such as Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM1) and Cystatin C (CysC) have been suggested. However, in high-risk CS patients their role for assessing renal injury has not yet been investigated in comparison to the most widely used serum creatinine. METHODS: This predefined substudy included 190 patients of the randomizedIntraaortic Balloon Pumpin Cardiogenic Shock II (IABP-SHOCK II)-trial. Blood samples were collected directly during primary percutaneous coronary intervention, one day and two days after randomization. The primary endpoint for outcome assessment was 1 year mortality. RESULTS:Creatinine, NGAL and KIM-1 were significantly higher in non-survivors in comparison to survivors over time in ANOVA (p<0.001; p=0.002 and p=0.04, respectively). In contrast, CysC levels were not associated with the primary endpoint (p=0.15). Receiver operator characteristics revealed that creatinine at any time point had the best predictive value for 1 year mortality. This was also true when comparing creatinine to different equations for glomerular filtration rate. In multivariable Cox-regression analysis creatinine remained the only significant independent predictor of kidney biomarkers of time to death during the first year. CONCLUSIONS: Assessment of novel biomarkers such as CysC, NGAL and KIM-1 or calculation of glomerular filtration rate provide no additional prognostic information in patients with CS complicating acute myocardial infarction in comparison to creatinine.
RCT Entities:
BACKGROUND: In cardiogenic shock (CS) renal dysfunction is an important parameter of inadequate end-organ perfusion and an independent predictor of adverse outcome. Early detection of renal dysfunction is therefore important, and novel biomarkers such as Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM1) and Cystatin C (CysC) have been suggested. However, in high-risk CS patients their role for assessing renal injury has not yet been investigated in comparison to the most widely used serum creatinine. METHODS: This predefined substudy included 190 patients of the randomized Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II)-trial. Blood samples were collected directly during primary percutaneous coronary intervention, one day and two days after randomization. The primary endpoint for outcome assessment was 1 year mortality. RESULTS:Creatinine, NGAL and KIM-1 were significantly higher in non-survivors in comparison to survivors over time in ANOVA (p<0.001; p=0.002 and p=0.04, respectively). In contrast, CysC levels were not associated with the primary endpoint (p=0.15). Receiver operator characteristics revealed that creatinine at any time point had the best predictive value for 1 year mortality. This was also true when comparing creatinine to different equations for glomerular filtration rate. In multivariable Cox-regression analysis creatinine remained the only significant independent predictor of kidney biomarkers of time to death during the first year. CONCLUSIONS: Assessment of novel biomarkers such as CysC, NGAL and KIM-1 or calculation of glomerular filtration rate provide no additional prognostic information in patients with CS complicating acute myocardial infarction in comparison to creatinine.
Authors: Kristine Krajnak; Hong Kan; Kristen A Russ; Walter McKinney; Stacey Waugh; Wen Zheng; Michael L Kashon; Claud Johnson; Jared Cumpston; Jeffrey S Fedan Journal: Toxicol Appl Pharmacol Date: 2020-09-12 Impact factor: 4.219
Authors: István Ferenc Édes; Balázs Tamás Németh; István Hartyánszky; Bálint Szilveszter; Péter Kulyassa; Levente Fazekas; Miklós Pólos; Endre Németh; Dávid Becker; Béla Merkely Journal: Postepy Kardiol Interwencyjnej Date: 2021-09-13 Impact factor: 1.426
Authors: N Ghionzoli; C Sciaccaluga; G E Mandoli; G Vergaro; F Gentile; F D'Ascenzi; S Mondillo; M Emdin; S Valente; M Cameli Journal: Heart Fail Rev Date: 2020-10-02 Impact factor: 4.214