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| The Research on the Correlation between Positive Fluid Balance and Acute Kidney Injury in Patients with ST-segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock |
| Zhan Peng, Xv Lei, Yang Tian-he |
| Zhang Yun-dong. Department of Heart Medicine, Anshun City People′s Hospital, Anshun, 561000, China |
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Abstract Objective To evaluate the correlation between fluid positive balance and acute kidney injury(AKI) in ST segment elevation myocardial infarction(STEMI) patients complicated by cardiogenic shock. Methods The clinical data of 192 patients with STEMI complicated by cardiogenic shock treated in CICU in our hospital were analyzed retrospectively. All patients were treated with fluid management treatment. The patients were divided into two groups according to whether there was a cumulative positive fluid balance at 96 h after admission: the positive fluid balance group (n=99) and negative fluid balance group (n=93). The fluid balance at 24, 48, 72 and 96 h was compared between two groups, and the cumulative fluid intake and output at 96 h were compared. The incidences of AKI, Serum creatinine(SCr) and AKI recovery were compared between the two groups. Pearson test was used to evaluate the relationship between fluid balance and related variables. Multivariate Logistic regression models were used to evaluate the independent predictors of AKI injury recovery. Results At the 24 h, 48 h, 72 h and 96 h, the fluid balance amout of the positive fluid balance group was significantly higher than that of the negative fluid balance group (all P<0.001), while the cumulative liquid input of the positive fluid balance group was significantly higher than that of the negative fluid balance group (t=16.543, P<0.001). The main factor influencing the fluid balance was that positive fluid balance group had more liquid inputs and no less-fluid outputs during the treatment. Compared with the negative fluid balance group, the patients in the positive fluid balance group had a higher incidence of AKI stage 2 to 3 (51.7% vs. 12.5%, χ2= 20.172, P<0.001) . The renal functional recovery rate was lower ［28.3% (17/60) vs. 75.0% (42/56), χ2= 25.240, P<0.001］. The fluid balance of patients with positive fluid balance was positively correlated with the change peak value of SCr(r=0.432, P=0.005). Positive fluid balance is closely related to the reduction to the possibility of renal function recovery in patients. Conclusion In patients with STEMI complicated by cardiogenic shock, fluid positive balance is closely related to a significant worsening of renal function and a reduced likelihood of renal function recovery.
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