Key result
Moderate-to-severe acute kidney injury was significantly associated with an increased risk of 1-year mortality (HR 1.22) compared to normal-or-mild acute kidney injury in ICU patients with acute myocardial infarction.
Why the study?
The impact of KDIGO AKI staging, particularly early-stage AKI, on post-discharge short- and long-term outcomes after acute myocardial infarction was not well understood.
Does the severity of acute kidney injury (KDIGO stage) affect short- and long-term mortality in adult patients with acute myocardial infarction?
Cohort (n=5,715)
No
Does the severity of acute kidney injury (KDIGO stage) affect short- and long-term mortality in adult patients with acute myocardial infarction?
Hazard Ratio: 1.22 (95% CI 1.07–1.38)
p-value: p=<0.001
In patients with acute myocardial infarction, moderate-to-severe AKI significantly worsens short- and long-term mortality, whereas mild AKI has a prognosis similar to no AKI.
Stage 1 AKI post-AMI associates with worse outcomes; hypothesis-generating for risk stratification, needs prospective trials.
Background Acute kidney injury (AKI) following acute myocardial infarction (AMI) notably affects patient outcomes. The impact of KDIGO AKI staging on post-discharge short- and long-term outcomes, particularly early-stage AKI, is not well understood. This study evaluates the prognostic implications of various KDIGO stages in AMI patients. Methods Utilizing the Medical Information Mart for Intensive Care IV (version 3.0) database, this retrospective cohort study included adult patients primarily diagnosed with AMI. Statistical analyses, including doubly robust estimation, propensity score matching, logistic regression, and Cox regression, were performed. The study compared Non-AKI (KDIGO stage 0) with Mild-AKI (maximum KDIGO stage 1 during hospitalization), and Normal-or-mild AKI (KDIGO stages 0–1) with Moderate-to-severe AKI (KDIGO stages 2–3). Results Among 5,715 patients analyzed, 4,306 (75.36%) developed AKI. Doubly robust analysis revealed no significant differences in outcomes between Non-AKI and Mild-AKI groups (28-day mortality: OR 0.97, 95% CI 0.68–1.38; 180-day mortality: HR 0.94, 95% CI 0.76–1.18; 1-year mortality: HR 0.98, 95% CI 0.81–1.20). However, Moderate-to-severe AKI was significantly associated with worse outcomes compared to Normal-or-mild AKI (28-day mortality: OR 1.67, 95% CI 1.36–2.05; 180-day mortality: HR 1.06, 95% CI 1.02–1.10; 1-year mortality: HR 1.22, 95% CI 1.07–1.38; all p < 0.001). Subgroup analyses revealed that patients under 65 years with Mild-AKI showed higher risks of 180-day and 1-year mortality compared to Non-AKI, while Moderate-to-severe AKI consistently demonstrated worse outcomes across all subgroups (age, SOFA score, heart failure status, and renal disease status). These findings were robust across multiple sensitivity analyses. Conclusions Patients with Mild-AKI can be considered as having “subclinical AKI,” with prognoses similar to Non-AKI patients. In contrast, Moderate-to-severe AKI significantly worsens prognosis compared to Normal-or-mild AKI.
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Guo et al. (2025) conducted a cohort in Acute myocardial infarction with acute kidney injury (n=5,715). Moderate-to-severe acute kidney injury (KDIGO stages 2-3) vs. Normal-or-mild acute kidney injury (KDIGO stages 0-1) was evaluated on 1-year mortality (HR 1.22, 95% CI 1.07-1.38, p=<0.001). Moderate-to-severe acute kidney injury was significantly associated with an increased risk of 1-year mortality (HR 1.22) compared to normal-or-mild acute kidney injury in ICU patients with acute myocardial infarction.
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