CALL K score in cardiac [Autosaved].pptx

this score for predicting the need for renal replaxement theraphy in cardiogenic shock

this score have advantages like the simplicity, quick and dont need another measurement

1. CALL-K score: Predicting the Need For Renal Replacement Therapy in Cardiogenic Shock Journal Reading Divisi CVCU Presented by : Abdillah Lubis Supervised by : dr. Andika Sitepu , Sp.JP (K), MHkes PENYAKIT JANTUNG DAN PEMBULUH DARAH DEPARTEMEN KARDIOLOGI DAN KEDOKTERAN VASKULAR FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA MEDAN 2022

2. Abstract Assesses the impact of RRT on mortality in patients with CS and aims to identify clinical factors that contribute to the need of RRT. Prospective registry of cardiac intensive care unit Admissions at a single institution between 2014 and 2020. RRT is associated with worse outcomes, including a lower likelihood to receive advanced heart failure therapies in patients with CS.

3. Introduction Cardiogenic shock (CS) Complex condition High mortality Haemodynamic and metabolic derangements Multi-organ failure Admission in cardiac intensive care units (CICUs) Mechanical ventilation, mechanical circulatory support and renal replacement therapy (RRT) are often required

4. CS can lead acute kidney injury (AKI) in patients with normal baseline Haemodynamic imbalances Poor perfusion and venous congestion Cardiorenal syndrome (CRS) type 1 Chronic heart failure (HF) Persistently reduced kidney function and chronic kidney disease (CKD) CRS type 2 Can be worsened by an acute presentation of CS 1 2

5. Potential benefits of RRT in volume overload patient Different modalities in HF with variable results Trial in critical care setting in non-CS cases Delaying the start of RRT is safe and reduces adverse events Didn’t exist in the CS population

6. RRT Decongestion and improved renal perfusion May be beneficial in the CS population Delaying RRT may lead to worse outcomes Associated with increased mortality Observational data from CICU population Identifying patients at risk early Only creatinine

7. Aim of this study This study explores the impact that RRT has on the outcomes of patients with CS, and identifies additional risk factors associated with the need for RRT in CS

8. Methods- Design Location Toronto General Hospital CICU Subject All the consecutive patients with CS admitted Time From 1 january 2014 to 31 december 2020 Clinical information was obtained from patient electronic medical records Exclude criteria: Patients who required RRT prior to CICU admission Variable to CICU  d emographics, vital signs, laboratory, and haemodynamic eGFR calculated using the CKD-EPI formula

9. Cardiogenic shock was defined as per the SHOCK trial Severity CS : according to the CS working group-adapted definition of SCAI stages Primary outcome : the need for RRT during CICU stay RRT : receiving at least one session of any form of RRT Invasive haemodynamic parameters: PAC, CI, CO, CVP, MAP, PCWP, pulmonary pressures, renal perfusion pressure (MAP—CVP)

10. Secondary outcomes 30-day and 1-year mortality, Orthotopic heart transplant (OHT) Implant of a durable left ventricular assist device (LVAD) Sepsis Ventilator-associated pneumonia Length of mechanical ventilation CICU stay All data up to the latest clinical follow-up or time of death were included in the analysis

11. Methods- Statistical analysis Categorical variables  count and percentage Median and interquartile range  quantitative variables Categorical variables  x 2 test or Fisher’s test Quantitative variables  a t-test or a Mann–Whitney rank-sum test Data distributed  Shapiro–Wilk test Correlation  Pearson’s coefficient

12. Lowest akaike information criterion  best model Missing values  exclude Area under the curve (AUC) compared using the De Long test with creatinine at admission Internal validation  cross-validation with 30 subsamples & calibration was assessed graphically  Hosmer– Lemeshow and Pearson’s X 2 tests  Stata 15.0 for Mac

13. RESULT 1030 patients CS 123 (11.9%) required RRT no differences between acute myocardial infarction-related CS and those with acute decompensated HF-CS. Patients requiring RRT  older, >>> BMI, <<< Hb, <<< Plt , >>> Cr, >>> Potassium  admission >>> lactate, >>> B-type natriuretic peptide, >>> received vasopressors, >>> likely to have an intra-aortic balloon pump inserted, >>> need mechanical ventilation

14. older BMI >>>

15. <<< Hb <<< Plt >>> Cr >>> Potasium

16. >>> >>> >>>

17. 30 days following 323 (31,4%) died 62 (50,4%) undergoing RRT 261 (28,8%) not receiving RRT

18. RRT associated with sepsis, ventilator-associated pneumonia, prolonged length of mechanical ventilation, and CICU stay

19. patients in RRT group More frequently referred to palliative care after discharge Received less HF education at time of discharge Less likely to be seen in an HF clinic after discharge No difference was seen in the referral to cardiac rehabilitation programmes

20. Permanent dialysis  71.9% survivors who received RRT during admission Median creatinine who did not require dialysis  153 RRT increased risk of 1-year mortality Impact on mortality of RRT was dependent of eGFR at admission

21. Calibration of the CALL-K score to predict the need for RRT was excellent (Hosmer- Lemeshow test P = 0.827; Pearson X 2 test = 0.918)

22. DISCUSSION This study Comprehensive analysis of RRT use Initiating RRT  associated with unfavourable short- and long-term outcomes & reduces probability for advanced HF therapies The risk of requiring RRT in CS  CALL-K score  simple risk score  5 variables

23. RRT  has negative impact on mortality in patients with CS Sicker than do not require the intervention Present study  no longer seen between RRT requirement and short-term mortality Still significant for 1-year mortality Only a minority in RRT group received advanced HF therapies Patients who were discharged after receiving RRT were less frequently on optimal medical treatment at the time of discharge

24. 1 st risk score to predict the use of RRT in CS 5 clinical variables Categorized as low (<1%), intermediate (1–10%), high (10–30%), or very high (>30%) Lactate reflects the severity of CS Hb  marker of disease severity  mediator role in AKI  promoting renal arterial vasoconstriction & decreasing renal blood flow CALL-K score

25. ESCAPE Relationship between RRT and invasive assessment Heterogeneous population with patients with HF Did not study patients with CS But, our results mirror those seen in the ESCAPE trial

26. All variables available within first hour of admission Allow clinician to assess the risk of RRT early Improve communication Help early planning and logistics of implementation therapy & comparing populations CALL-K score strengths

27. Single centre Inherent risk of bias Higher number in stage D and E Invasive haemodynamic measurements only available in a minority Limitations Diuretic efficiency or serum biomarkers of kidney damage not available

28. Conclusion RRT is utilized in ~12% of patients CALL-K score, a novel, easy-to-calculate risk score for the need for RRT in CS, with good discrimination and calibration

29. THANK YOU