Prognosis of patients who develop acute renal failure during the first 24 hours of cardiogenic shock after myocardial infarction

Abstract Purpose Acute renal failure has important prognostic implications in critically ill patients, but the effects of acute renal failure on in-hospital mortality in the subset of patients with cardiogenic shock are not known. Subjects and methods All consecutive patients who presented with acute coronary syndrome at our cardiovascular intensive care unit from 1993 to 2000 and who were in cardiogenic shock were enrolled. Acute renal failure was defined as a urine volume <20 mL/h associated with an increase in serum creatinine level ≥ 0.5 mg/dL or > 50% above the baseline value. Results There were 118 patients (83 men [70%]; mean [± SD] age, 66 ± 10 years), 39 (33%) of whom developed acute renal failure within 24 hours after the onset of shock. In-hospital mortality was 87% (34/39) in patients with acute renal failure and 53% (42/79) in patients without acute renal failure (odds ratio [OR] = 6.0; 95% confidence interval [CI]: 2.1 to 17; P< 0.001). Other significant univariate predictors of mortality included the peak serum lactate level, epinephrine dose, and the maximum serum creatinine level. Multivariate logistic regression analysis identified acute renal failure as the only independent predictor of mortality. Conclusion Acute renal failure was common in patients with cardiogenic shock and strongly associated with in-hospital mortality.