Timing of acute kidney injury in infarction-related cardiogenic shock: early onset signals a high-risk phenotype – a retrospective observational study

  1. Priyanka Boettger
  2. Henriette Preusse-Sondermann
  3. Jamschid Sedighi
  4. Jannik Jobst
  5. Hassan Hassan
  6. Utku Bayram
  7. Kerstin Piayda
  8. Matthias Janusch
  9. Birgit Assmus
  10. Bernhard Unsoeld
  11. Henning Lemm
  12. Samuel Sossalla
  13. Michael Buerke
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Abstract

Background

Acute kidney injury (AKI) is common in cardiogenic shock (CS) and increases mortality, but the prognostic impact of onset timing in infarct-related CS is unclear. We examined whether early versus late AKI onset is associated with differences in patient characteristics and outcomes.

Methods

In this retrospective observational study, 369 patients with infarct-related CS were classified by AKI timing within the first 96 h of admission: early (≤ 48 h) or late (> 48 h), according to KDIGO criteria. Clinical, hemodynamic, and inflammatory parameters and outcomes were compared. Multivariable logistic regression identified independent predictors of early AKI and in-hospital mortality.

Results

AKI occurred in 143 patients (38.8%), with 56.6% early-onset. In-hospital mortality was higher with early AKI than late AKI (71.6% vs. 54.8%; absolute difference 16.8%, 95% CI 3.1–30.5; p  = 0.018). Early AKI patients had higher lactate at admission (median 4.3 vs. 3.1 mmol/L; p  = 0.028), greater norepinephrine requirements (0.34 vs. 0.21 µg/kg/min; p  = 0.044), and more frequent mechanical ventilation (81.5% vs. 61.3%; p  = 0.011). In multivariable analysis, early AKI independently predicted in-hospital mortality (adjusted OR 2.12, 95% CI 1.16–3.87; p  = 0.015), and was associated with baseline creatinine (OR 5.68 per 1 mg/dL, p  = 0.008) and 24-h lactate (OR 2.67 per mmol/L, p  < 0.001).

Conclusions

In infarct-related CS, AKI within 48 h marks a high-risk hemodynamic phenotype with markedly increased mortality, driven by renal vulnerability and early hypoperfusion. Incorporating AKI timing into risk stratification may help target early renoprotective interventions. Keywords: Acute kidney injury; cardiogenic shock; myocardial infarction; AKI timing; early-onset AKI; hemodynamic instability; lactate; renal dysfunction; in-hospital mortality

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  1. Version published to 10.1186/s12882-025-04730-y
  2. Version published to 10.21203/rs.3.rs-7511711/v1 on Research Square