The aim of the study is to diagnose acute kidney injury, its severity, and types in patients with pulmonary artery thromboembolia (PATE), to establish the correlation between AKI and the estimated mortality risk, hospital mortality. Materials and Methods. The study enrolled 111 patients (61 males (55 %), and 50 females (45 %), average age 66.8±11.7 years) with PATE, hospitalized to the cardiology department of Ulyanovsk Central City Clinical Hospital. Results. Acute kidney injury was diagnosed in 36 patients with PATE (34 %): among them 24 patients with stage 1 PATE (67 %); 7 patients with stage 2 (19 %); 5 patients with stage 3 (14 %). Prehospital complications were diagnosed in 20 patients (56 %), hospital AKI was detected in 16 patients (44 %). CKD-associated AKI was observed in 24 patients (67 %), de novo AKI was diagnosed in 12 trial subjects (33 %). Twenty-six patients (23 %) died during hospitalization. The relative hospital mortality risk in AKI patients was 5.2 (95 % CI: 2.02–13.39; p<0.001). The estimated risk of 30-day mortality according to the PESI score was higher in AKI patients (120.0 (87.5–158,0) and 90 (87.5-158.0), respectively, p=0.004). Conclusion. Patients with PATE had a high incidence of AKI, which was diagnosed in every 3rd patient. In 67 % of patients, AKI was associated with chronic kidney disease. Patients with prehospital AKI prevailed (56 %). AKI in patients with PATE was associated with increased in-hospital mortality and an estimated 30-day mortality risk. Keywords: acute kidney injury, pulmonary embolism, hospital mortality, estimated mortality risk. Цель исследования. Оценить наличие, степень выраженности и варианты острого повреждения почек (ОПП) у пациентов с тромбоэмболией легочной артерии (ТЭЛА); уточнить связь между ОПП и расчетным риском смерти, госпитальной летальностью. Материалы и методы. Обследовано 111 пациентов (мужчин – 61 (55 %), женщин – 50 (45 %), средний возраст – 66,8±11,7 года) с ТЭЛА, госпитализированных в отделение кардиологии ГУЗ «Центральная городская клиническая больница г. Ульяновска». Результаты. Острое повреждение почек диагностировано у 36 (34 %) пациентов с ТЭЛА, причем у 24 (67 %) из них выявлена 1 стадия, у 7 (19 %) – 2 стадия и у 5 (14 %) – 3 стадия. У 20 (56 %) пациентов диагностирован догоспитальный вариант осложнения, госпитальное ОПП выявлялось в 16 (44 %) случаях. ОПП при ХБП имело место у 24 (67 %) обследованных, ОПП de novo – у 12 (33 %). В период госпитализации умерло 26 (23 %) пациентов. Относительный риск смерти в стационаре у пациентов с ОПП составил 5,2 (95 % ДИ: 2,02–13,39; р<0,001). Расчетный риск 30-дневной смерти по шкале PESI при наличии ОПП был выше, чем при его отсутствии (120,0 (87,5–158,0) и 90 (87,5–158,0) соответственно, p=0,004). Выводы. У пациентов с ТЭЛА наблюдается высокая частота ОПП, оно диагностируется у каждого 3-го пациента. У 67 % пациентов острое повреждение почек развивается на фоне предшествующей хронической болезни почек. Преобладают пациенты с догоспитальным ОПП (56 %). Острое повреждение почек у пациентов с ТЭЛА ассоциировано с увеличением госпитальной летальности и расчетного риска 30-дневной смертности. Ключевые слова: острое повреждение почек, тромбоэмболия легочной артерии, госпитальная летальность, расчетный риск смерти.

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR) <60 ml/ min/1,73 m2. Risk of early (hospital or 30-day) death was stratified in accordance with the current 2019 ESC Clinical Guidelines. During the study, we analyzed inpatient mortality and complication rate.Results. A total of 604 patients (men, 293 (49%); women, 311 (51%)) were in the study. RD was detected in 320 (53%) patients, while severe dysfunction — in 63 (10%) ones. In addition, 71 (12%) patients had high death risk, 364 (61%) — intermediate, 164 (27%) — low. During hospitalization, 107 (18%) patients died, including 32% from the high-risk group, 20% — moderate, and 7% — low. RD in the deceased patients was diagnosed more often, while GFR <50 ml/min/1,73 m2 reliably predicted hospital mortality (sensitivity, 67%; specificity, 72%; AUC=0,72; p<0,001). In patients with simplified Pulmonary Embolism Severity Index (sPESI) of 0 and ≥ 1, the presence of RD led to at least a 2-fold increase in mortality. Multivariate Cox regression revealed that RD is a predictor of in-hospital mortality (hazard ratio (HR), 3,41; 95% confidence interval (CI): 2,15-5,41; p<0,001), regardless of the presence of death risk reclassifies, such as high troponin (HR, 1,31; 95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (HR, 1,23; 95% CI: 0,74-2,04; p=0,42).Conclusion. In patients with PE of the Russian population, there is a high incidence of RD, which is diagnosed in every second patient and is severe in 10% of cases. The presence of RD is associated with a significant increase in in-hospital mortality, while the risk of death increases with a decrease in GFR. The addition of RD, considered as a decrease in the estimated GFR <60 ml/min/1,73 m2, to the sPESI improves risk stratification and allows identification of patients at high risk of in-hospital death.

Aim. To evaluate the incidence and severity of acute kidney injury (AKI), as well as its ability to reclassify the risk of premature mortality and association with inhospital mortality in patients with pulmonary embolism (PE) in the Russian population.Material and methods. From April 2018 to April 2019, the SIRENA Russian Multicenter Registry included patients with PE, as well as the deceased, in whom the PE was detected by autopsy. AKI was diagnosed according to current KDIGO guidelines (2012). Creatinine calculated according to the MDRD equation and corresponding to a glomerular filtration rate of 75 ml/min/1,73 m2 (baseline) was taken as the initial one, with subsequent assessment relative to the parameter value upon admission. The risk stratification of early death was carried out in accordance with the current ESC clinical guidelines (2019).Results. A total of 604 patients with PE were examined (men — 293 (49%), women — 311 (51%), mean age — 64±15 years). AKI was diagnosed in 223 (37%) of them. Stage 1 AKI was detected in 146 (65%), 2 — in 55 (25%), 3 — in 22 (10%) patients. Prior chronic kidney disease was recorded in 61 (10%) patients. Seventy-one (12%) patients had a high risk of death, 364 (61%) — intermediate risk, and 164 (27%) — low risk. The AKI incidence increased as the severity of PE increased: at low risk of death — 26%, intermediate — 38%, high — 59% (p<0,0001). In total, 107 (18%) patients died in the hospital. AKI led to an increase in mortality within following risk groups: at low risk, this effect was a trend (6 (5%) vs 6 (14%); p=0,052); at intermediate and high risk, significant differences was obtained (30 (13%) vs 41 (30%), p<0,001; 4 (14%) vs 19 (45%), p=0,006, respectively). Multivariate Cox regression demonstrated that AKI is a predictor of inhospital death (odds ratio (OR), 3,66 (95% confidence interval (CI): 2,37-5,66; p<0,0001), regardless of increased troponin levels (OR, 1,31 (95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (OR, 1,23 (95% CI: 0,74-2,04; p=0,42).Conclusion. Thirty-seven percent of Russian patients with PE have AKI diagnosed by baseline creatinine. In 2/3 of the examined patients, stage 1 AKI is observed. The AKI incidence increases as the severity of PE increases. The presence of AKI reclassifies patients into a higher risk category for death and is associated with a significant increase in inhospital mortality.

Нацiональний технiчний унiверситет України "Київський полiтехнiчний iнститут iм. Iгоря Сiкорського" 2 Нацiональний iнститут серцево-судинної хiрургiї iм. М.М. Амосова НАМН України