• Gilad Margolis, Natalia Kofman, Amir Gal-Oz, Yaron Arbel, Shafik Khoury, Gad Keren, and Yacov Shacham.
• Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: gilad.margolis@gmail.com.
• J Crit Care. 2017 Aug 1; 40: 184-188.

PurposeWe analyzed the relationship between a positive fluid balance and its persistence over time on acute kidney injury (AKI) development, severity and resolution among ST elevation myocardial infarction (STEMI) patients complicated by cardiogenic shock.MethodsWe retrospectively studied the cumulative fluid balance intake and output at 96h following hospital admission in 84 consecutive adult patients with STEMI complicated by cardiogenic shock. The cohort was stratified into two groups, based on the presence or absence of positive fluid balance on day 4. Patients' records were assessed for the development of AKI, AKI severity and recovery.ResultsPatients having positive fluid balance were more likely to develop a more severe AKI stage (52% vs. 13%; p<0.001), were less likely to have recovery of their renal function (29% vs. 75%, p=0.001), and demonstrated positive correlation between the amount of fluid accumulated and the rise in serum creatinine (R=0.42, p=0.004). For every 1l increase in positive fluid balance, the adjusted possibility for recovery of renal function decreased by 21% (OR=0.796, 95% CI 0.67-0.93; p=0.006).ConclusionsA positive fluid balance was strongly associated with higher stage AKI and lower rate of AKI recovery in STEMI complicated by cardiogenic shock.Copyright © 2017 Elsevier Inc. All rights reserved.

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