Abstract
Introduction
Acute kidney injury (AKI) is common in cardiogenic shock (CS), but its prognostic significance has been defined mainly in myocardial infarction-related CS and may not generalize to heart failure-related CS (HF-CS), a critical gap in risk stratification.
Methods
MEDLINE, Embase, and Web of Science were searched through November 2025 for cohort studies comparing mortality with versus without AKI in HF-CS, excluding myocardial infarction- or post-cardiotomy-related CS. Primary outcome was all-cause mortality (ACM) at 30, 90, and 180 days. Crude hazard ratios (cHRs) were pooled via random-effects models; when unavailable, individual participant data were reconstructed from Kaplan-Meier curves and analyzed via Cox regression. Leave-one-out analysis was performed.
Results
Of 4,926 screened studies, four cohort studies (N=1,333) met inclusion criteria. AKI was associated with significantly higher ACM at 30 days (cHR 2.31; 95% CI 1.44–3.71; p=0.0005), 90 days (cHR 2.34; 95% CI 1.33–4.14; p=0.003), and 180 days (cHR 2.14; 95% CI 1.16–3.96; p=0.01). Pooled reconstructed Kaplan-Meier curves confirmed sustained survival divergence favoring no-AKI patients at 30 days (HR 1.72; 95% CI 1.46–2.04; p0.001) and 90 days (HR 2.48; 95% CI 1.47–4.17; p0.001). Substantial 30-day heterogeneity, driven by Sundermeyer et al., resolved on its exclusion (I²=0%). AKI stage 3 showed the highest pooled mortality risk (cHR 3.26; 95% CI 0.68–15.65; p=0.14), consistent with Sundermeyer et al. (aHR 1.97; 95% CI 1.56–2.48; p0.001).
Conclusion
AKI predicts sustained higher mortality in HF-CS, a clinically meaningful prognostic marker warranting larger prospective studies on optimal AKI management.