title: Incidence and relevance of acute kidney injury in patients hospitalized with acute coronary syndromes.
abstract: Acute kidney injury (AKI) occurs frequently in patients with acute coronary syndromes (ACS) and is associated with adverse short- and long-term outcomes. To date, however, no standardized definition of AKI has been used for patients with ACS. As a result, information on its true incidence and the clinical and prognostic relevance according to the severity of renal function deterioration are still lacking. We retrospectively studied 3,210 patients with ACS. AKI was identified on the basis of the changes in serum creatinine during hospitalization according to the AKI Network criteria. Overall, 409 patients (13%) developed AKI: 262 (64%) had stage 1, 25 (6%) stage 2, and 122 (30%) stage 3 AKI. In-hospital mortality was greater in patients with AKI than in those without AKI (21% vs 1%; p <0.001). The adjusted risk of death increased with increasing AKI severity. Compared to no AKI, the adjusted odds ratio for death was 3.5 (95% confidence interval 1.79 to 6.83) with stage 1 AKI and 31.2 (95% confidence interval 16.96 to 57.45) with stage 2 to 3 AKI. A significant parallel increase in major adverse cardiac events was also observed comparing patients without AKI and those with stage 2 to 3 AKI. In conclusion, in patients with ACS, AKI is a frequent complication, and the graded increase of its severity, as assessed using the AKI Network classification, is associated with a progressive increased risk of in-hospital morbidity and mortality.
authors.affiliation: Centro Cardiologico Monzino, I.R.C.C.S., Department of Cardiovascular Sciences, University of Milan, Milan, Italy. giancarlo.marenzi@ccfm.it
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marenzi
authors.forename: Angelo
authors.initials: A
authors.lastname: Cabiati
authors.forename: Silvio V
authors.initials: SV
authors.lastname: Bertoli
authors.forename: Emilio
authors.initials: E
authors.lastname: Assanelli
authors.forename: Ivana
authors.initials: I
authors.lastname: Marana
authors.forename: Monica
authors.initials: M
authors.lastname: De Metrio
authors.forename: Mara
authors.initials: M
authors.lastname: Rubino
authors.forename: Marco
authors.initials: M
authors.lastname: Moltrasio
authors.forename: Marco
authors.initials: M
authors.lastname: Grazi
authors.forename: Jeness
authors.initials: J
authors.lastname: Campodonico
authors.forename: Valentina
authors.initials: V
authors.lastname: Milazzo
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Lauri
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology*; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index