Prognostic impact of acute kidney injury in patients with acute pulmonary embolism.Data from the RIETE registry

Abstract

Background: Acute kidney injury (AKI) is frequent in patients with acute pulmonary embolism (PE). The potential impact of AKI on PE, particularly beyond the traditional risk stratification system, remains unknown.

Aims and objectives: We sought to determine whether AKI assessment according to Kidney Disease: Improving Global Outcomes (KDIGO) improves risk stratification made based on the hemodynamic status, and simplified Pulmonary Embolism Severity Index (sPESI) in patients with acute PE.

Methods: We analysed patients with acute PE, included in the multicenter international RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Patients categorized as hemodynamically unstable were at high-risk. Normotensive patients were stratified according to the sPESI score (low-risk: sPESI=0; intermediate-risk: sPESI>0). We explored the presence of AKI in all three subgroups. The primary outcome was all-cause 30-day mortality. Secondary outcomes were major bleeding and VTE recurrences during the same period.

Results: 30,532 consecutive patients with acute PE were analyzed. 3.6% were classified to be at high-risk, 34.6% at low-risk, and the remaining 61.8% at intermediate-risk of 30-days mortality. At baseline, 26% had AKI. The presence of AKI was associated with significantly increased mortality rates in low-risk patients (from 0.46% to 3%), intermediate-risk (from 5.4% to 10%), and high-risk patients (from 9.4% to 18%) (p<0.001 for all). AKI presence was also associated with an increased risk of major bleeding in each subgroup.

Conclusions: Addition of the AKI status improved the prediction of the 30-day mortality and bleeding rates for in all sub-group of patients with PE.