Highlights
- •The incidence of Acute kidney injury (AKI) in patients primarily hospitalized for Acute heart failure (AHF) in 24.3%.
- •AKI in AHF hospitalization is associated with significantly higher in-hospital mortality, longer duration of hospital stay and an increased cost of hospitalization.
- •Patients presenting with AKI in AHF have higher rates of in-hospital complications including cardiac arrest, cardiogenic shock, transfusion of blood and blood products, and vascular complications.
- •Patients presenting with AKI in AHF undergo more invasive procedures including permanent pacemaker implantation, implantable cardioverter defibrillation, cardiac resynchronization and mechanical ventilation.
- •There has been a steady increase in the incidence of AKI among patients hospitalized with AHF between the year 2012-2014 in the United States.
Abstract
Aim
We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes
in patients presenting with acute heart failure (AHF). Data from National Inpatient
Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF
and the concomitant secondary diagnosis of AKI.
Methods
Propensity score matching was performed on 30 baseline variables to identify a matched
cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital
procedures and complications.
Results
Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching
a matched cohort of 356,940 patients was identified. In this matched group, the AKI
group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications
such as sepsis, transfusions and cardiac arrest were also higher in the AKI group
(p<0.01). Similarly, in-hospital procedures including pacemaker, coronary artery bypass
graft, mechanical ventilation and intra-aortic balloon pump were performed more in
the AKI group compared to the non-AKI group. The rate of AKI in patients with AHF
has gradually increased from 29 % in the year 2012 to 35% in 2014. AHF patients with
AKI had longer in-hospital stay of ~1.7 days.
Conclusion
In this propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital
mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications
were higher in the AKI group.
Keywords
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Article info
Publication history
Published online: June 05, 2020
Accepted:
May 29,
2020
Received in revised form:
April 30,
2020
Received:
March 21,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
