Is the mean platelet volume a predictive marker of a high in-hospital mortality of acute cardiorenal syndrome patients receiving continuous renal replacement therapy?

Abstract

A high mean platelet volume (MPV) level has been demonstrated to predict poor clinical outcomes in patients with cardiovascular disease. However, the relationship between MPV and mortality in patients with acute cardiorenal syndrome (ACRS) is unknown. Therefore, we investigated the predictive value of MPV for in-hospital mortality of patients with ACRS who received continuous renal replacement therapy (CRRT) in this study.We retrospectively analyzed the demographics, etiology, severity of illness, prognosis, and risk factors of ACRS patients who underwent CRRT in our hospital from January 2009 to December 2014. Patients were classified into 2 groups based on the prognosis and timing of CRRT. The receiver operating characteristic curve was used to examine the performance of MPV in predicting in-hospital mortality. Baseline characteristics, clinical, and hematological parameters at CRRT initiation were compared between the 2 groups. Factors influencing in-hospital mortality were analyzed by univariate logistic regression analysis.The median age of patients was 74 years. Acute myocardial infarction was the most common cause of ACRS, followed by acute decompensated heart failure. The in-hospital mortality was 51.4%. Age, number of organ failure, APACHE II score, and MPV in the nonsurvivors were significantly higher than those in the survivors (P < .05). However, the cardiac function and mean arterial pressure were significantly lower in the nonsurvivors (P < .05). The prognosis of the early intervention group was better than the late-intervention group, but no significant difference was found (P > .05). The area under the curve (AUC) for in hospital mortality based on MPV was 0.735. Univariate analysis showed that age, cardiac function NYHA class, number of organ failure, APACHE II score, MAP, MPV, and use of vasopressors were associated with the prognosis of patients (P < .05).These findings suggest that the prognosis of patients with ACRS who received CRRT was poor, and MPV might be useful as a marker for predicting the in-hospital mortality of these patients.

Fatores preditivos para o desenvolvimento da síndrome cardiorrenal em pacientes com insuficiência cardíaca

“…Dentre seus mecanismos fisiopatológicos, destacam-se os mecanismos hemodinâmicos, levando a uma hipoperfusão renal e redução na taxa de filtração glomerular e os não-hemodinâmicos, como atuação do sistema nervoso simpático e a ativação do sistema renina-angiotensina-aldosterona, inflamação crônica e desequilíbrio entre a produção de espécies reativas de oxigênio e de óxido nítrico. É mais comum em pacientes com síndrome coronariana aguda (Li et al, 2018;Zhang et al, 2018;Virzì et al, 2019).…”

“…Um aumento do volume plaquetário médio já foi demonstrado ser um fator preditivo para desfechos clínicos desfavoráveis em pacientes com doença cardiovascular, entretanto, o mesmo ainda não foi demonstrado em pacientes com síndrome cardiorrenal. Tal aumento está relacionado com um aumento na produção e ativação plaquetária, fenômeno que é uma característica marcante na inflamação, podendo ser usado como um biomarcador inflamatório (Li et al, 2018;.…”

“…Plaquetas grandes contêm maior quantidade de citocinas pró-trombóticas e esses fatores possuem variedade de efeitos na função endotelial e na inflamação associada com doença cardiovascular. Ademais, o aumento no volume plaquetário médio é um fator preditor independente de mortalidade em injúria renal aguda (Li et al, 2018;Zhang et al, 2018).…”

“…Constatou-se que 35 pacientes desenvolveram síndrome cardiorrenal tipo 1. A partir da análise dos dados, foi possível estabelecer que o aumento no volume plaquetário médio pode ser um fator preditivo para mortalidade intra-hospitalar em curto prazo em pacientes com esse distúrbio (Li et al, 2018).…”

Predialysis Serum Lactate Levels Can Predict Dialysis Withdrawal in Type 1 Cardiorenal Syndrome Patients

“…Type 1 cardiorenal syndrome (CRS) is characterized by a rapid worsening of cardiac function and marked systemic congestion that absolutely or relatively causes a secondary insult to kidney function [1][2][3] . The appearance of CRS generally indicates a grave outcome, such as an increased risk of long-term mortality and end-stage renal disease 4 .…”