Combined Assessment of Urine Output and Renal Function Improves Risk Stratification in Heart Failure-related Cardiogenic Shock

Aims Renal impairment is common in heart failure–related cardiogenic shock (HF-CS), but its prognostic value in earlier stages of HF-CS is unclear. We investigated the prognostic value of renal dysfunction (RD) at HF-CS diagnosis, as well as creatinine- and oliguria-based acute kidney injury (AKI) within the first 24 hours after diagnosis. Methods We studied 394 patients with HF-CS, excluding those with out-of-hospital cardiac arrest or invasive ventilation at diagnosis. RD was staged per KDIGO chronic kidney disease criteria, with AKI crea defined as a creatinine increase ≥26.5 μmol/L (0.3mg/dL) and AKI uo as urine output <0.5 ml/kg/h over 24 hours. The primary outcome was 30-day mortality, while the secondary outcome was 1-year mortality. Results At HF-CS diagnosis, only RD KDIGO stage V was associated with 30-day mortality (adjusted HR, 3.28; 95% CI, 1.66–6.47). AKI crea was not associated with increased 30-day mortality (adjusted HR, 1.05; 95% CI, 0.66–1.66), whereas AKI uo was associated with higher mortality (adjusted HR, 1.92; 95% CI, 1.22–3.01). No interaction was observed between UO and loop diuretic dose for mortality (P = 0.893). At 1 year, both AKI crea (adjusted HR 1.46; 95% CI, 1.05–2.04) and AKI uo (adjusted HR, 1.64; 95% CI, 1.13–2.39) showed a relationship with increased mortality. Conclusions In HF-CS, oliguria during the first 24 hours of CS management was a strong predictor of 30-day mortality, independent of diuretic dose, as was RD stage V. Creatinine-based AKI was not associated with 30-day mortality. Both AKI crea and AKI uo were independent predictors of mortality at 1 year.