ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1580599
This article is part of the Research TopicCritical Care Cardiology for Cardiovascular EmergenciesView all 17 articles
RAPID-ONSET POSTOPERATIVE ACUTE KIDNEY INJURY IS ASSOCIATED WITH MORTALITY IN PATIENTS WITH POSTCARDIOTOMY CARDIOGENIC SHOCK
Provisionally accepted
- National Cerebral and Cardiovascular Center (Japan), Suita, Japan
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Background: Post-cardiotomy cardiogenic shock (PCCS) is a serious condition that necessitates veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Although acute kidney injury (AKI) often complicates PCCS, its specific effects on patient outcomes remain unclear. This study seeks to evaluate the impact of AKI on 90-day mortality.Methods: This retrospective study included 91 patients with postoperative cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation following cardiac surgery between 2013 and 2023. Rapid-onset AKI was defined as KDIGO Stage 2 or higher within 24 hours of ICU admission. Survival was analyzed using Kaplan-Meier and Cox regression methods to assess its association with 90-day mortality.Results: Twenty-four patients (26.4%) were classified as rapid-onset AKI. The median age, primary diagnosis, and preoperative serum creatinine levels were similar between groups.However, the rapid-onset AKI group had a preoperative lower left ventricular ejection fraction (42.5% vs. 60.0%, p = 0.006), longer cardiopulmonary bypass time (332 vs. 245 minutes, p = 0.009), and a longer duration of mechanical circulatory support (6.0 vs. 2.0 days, p = 0.001). The success rate of weaning from mechanical circulatory support was lower (61.1% vs. 93.3%, p = 0.002), and the 90-day cumulative survival probability was lower in the rapid-onset AKI group (29.1% [95% confidence interval (CI): 15.6-54.4 vs 79.1% [95% CI: 69.9-89.4], P<0.001). Cox regression analysis confirmed an independent association between rapid-onset AKI and 90-day mortality (adjusted hazard ratio: 3.15, 95%CI: 1.38-7.19, p = 0.006).Rapid-onset AKI was significantly associated with increased 90-day mortality in patients with PCCS who required VA-ECMO.
Keywords: Postcardiotomy cardiogenic shock, Acute Kidney Injury, Mechanical circulatory support, Veno-arterial extracorporeal membrane oxygenation, Extracorporeal life support, Ventricular assist device
Received: 20 Feb 2025; Accepted: 29 May 2025.
Copyright: © 2025 Tadokoro, Saku, Tonai, Tadokoro, Kutsuzawa and Fukushima. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Naoki Tadokoro, National Cerebral and Cardiovascular Center (Japan), Suita, Japan
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