Background: Acute kidney injury (AKI) complicating cardiogenic shock is associated with increased mortality. We hypothesize that renal replacement therapy (RRT) improves survival in cardiogenic shock supported by Impella-CP (Abiomed, Danvers, MA) complicated by AKI. Methods: A retrospective chart review identified 34 patients on Impella-CP for cardiogenic shock between January 2015 and December 2017. AKI was defined as an increase in serum creatinine≥0.3 mg/dL from baseline. Three groups were analyzed: AKI plus RRT, AKI minus RRT, and no AKI. Pre-existing dialysis patients were excluded. The only indication for RRT was AKI not responding to diuretics. Thirty-day mortality was analyzed. Results: There were 13 patients with no AKI, 9 with AKI plus RRT groups, and 12 with AKI minus RRT. Thirty-day mortality was similar between no AKI and AKI plus RRT groups [30.8% (4/13) vs.22.2% (2/9), p=0.48; relative risk [RR] 2.25 (95% confidence interval [CI] 0.22-22.1)]. Thirty-day mortality was higher in AKI minus RRT group compared to the no AKI group [75.0% (9/12) vs. 30.8% (4/13); p=0.03; RR 6.75 (95% CI 1.16-39.2)]. Conclusion: In cardiogenic shock patients on Impella-CP, AKI minus RRT is associated with a higher 30-day mortality compared to patients without AKI and/or patients with AKI plus RRT. Short-term mortality may improve in cardiogenic shock patients with AKI who are treated with RRT.
Acute neurological events are a common cause of ECG abnormalities and transient elevations in cardiac biomarkers. This case describes an uncommon presentation of cryptococcal meningitis in a non-immunosuppressed patient, presenting with altered sensorium and derangements in cardiac profile. Delay in diagnosing meningitis was avoided by paying close attention to the patient’s presenting symptoms and by pursuing non-cardiac causes of ECG changes and elevations in cardiac troponin. Expeditious treatment and involvement of the infectious disease consultant resulted in excellent clinical response without permanent neurological sequelae.
Background:
Acute kidney injury (AKI) complicating cardiogenic shock is associated with increased short-term mortality. We hypothesize that early HD or CRRT for AKI in patients with Impella-CP for cardiogenic shock improves survival.
Methods:
Retrospective chart-review identified 34 patients requiring Impella-CP for cardiogenic shock between January 2015 and December 2017. AKI was defined as increase in serum Cr >=0.3mg/dl or >=50% from baseline. Based on this definition, three groups were differentiated; no AKI, AKI without HD/CRRT and AKI+HD/CRRT. Pre-existing dialysis dependent patients were excluded. 30-day cardiovascular mortality (CV) was compared.
Results:
Of the 34 patients on Impella-CP for cardiogenic shock, 13 did not have AKI; 12 had AKI but did not receive HD/CRRT; and 9 received HD/CRRT for AKI. 30-day CV mortality was higher in the AKI without HD/CRRT group compared to no-AKI group [75% (9/12) vs 30.8% (4/13), p 0.03]. There was no significant difference in 30-day CV mortality of the AKI+HD/CRRT and no-AKI groups [22.2% (2/9) vs 30.8% (4/13), p 0.48]. In the 9 patients who received HD/CRRT, the indication was AKI not responding to diuretics. No other indications for HD were noted in all 34 patients. Hemoglobin >=11g/dl (p 0.008) and use of Calcium Channel Blockers (p 0.04) were associated with decreased incidence of AKI (Table 1). Mean serum creatinine was higher in the AKI+HD/CRRT than AKI without HD/CRRT group (p=0.01, Table 2).
Conclusion:
Despite the increased 30-day CV mortality associated with AKI in patients on Impella-CP for cardiogenic shock (p 0.03), there is no significant difference in 30-day CV mortality of patients who received HD/CRRT for AKI and those without AKI (p 0.48). Early initiation of HD/CRRT for AKI in patients on Impella-CP for cardiogenic shock may improve short-term CV mortality.
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