Glomerular Filtration Rate on Admission Independently Predicts Short-Term In-Hospital Mortality after Acute Myocardial Infarction

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Abstract
Background: Risk of cardiovascular events is higher in patients with chronic kidney disease. The objective is to evaluate whether glomerular filtration rate (GFR) on admission is an independent predictor of short-term mortality in acute myocardial infarction (AMI), after adjusting with physiologic derangements in an acute setting. Methods: 220 consecutive patients with an admitting diagnosis of AMI were enrolled in a 1-year prospective observational study at a tertiary care teaching institute. Data were gathered for history, physical examination and laboratory findings. GFR was calculated based on the Modification of Diet in Renal Disease formula. Abnormal categories of physiological derangement indicators were weighted based on APACHE II guidelines. The endpoint was defined as in-hospital all-cause mortality. Results: There were 31 deaths (14.1%). The GFR (mean ± SD) in survivors as compared to deceased patients was 68.2 ± 33.8 and 41.7 ± 25.1 ml/min/1.73 m2, respectively (p < 0.001). The mean age, white blood cell count, blood urea nitrogen, potassium and blood sugar were higher on admission in patients who died in hospital (p < 0.05), while the mean albumin, mean arterial pressure, pulse and respiratory rate were lower in this group compared to survivors (p < 0.05). After adjusting with other covariates, each 10 ml/min/1.73 m2 decrease in GFR was associated with a 1.29 times increased risk of mortality (95% CI 1.08–1.53, p = 0.004). Conclusion: GFR on admission is an independent predictor of short-term mortality in a patient after AMI.