ВАРИАНТ АЛГОРИТМА ПРОГНОЗИРОВАНИЯ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК ПРИ ИНФАРКТЕ МИОКАРДА У МУЖЧИН МОЛОЖЕ 60 ЛЕТ

Abstract

Relevance. Acute kidney injury (AKI) in myocardial infarction worsens the prognosis and increases the duration of treatment of patients. Aim. To evaluate the significance of the AKI development predictors during MI in males under 60 years old. To create a model for predicting the risk of developing this complication in the form of a diagnostic algorithm to improve prevention and outcomes. Material and methods. The study included men 32-59 years old (y.o.) with type I MI. Patients were divided into two age-comparable groups: I - study group, with AKI - 25 patients; II - control, without it - 166 patients. Pearson's Chi-square method was used to assess the absolute (AR) and relative (RR) risks of developing AKI under the influence of various factors. Mathematical modeling of the risk of developing this complication was performed using the classification tree method. Results. Among the features of predictors of AKI in myocardial infarction in the examined patients in comparison with the established risk factors for its development, the following were distinguished: stress (AR: 15.9%; p=0.01), winter season (AR: 21.8%; RR: 3.1; p=0.003), hypertriglyceridemia (≥1.8 mmol/l) (AR: 23.0%; p=0.007) and peptic ulcer (AR: 25.8; RR: 2.5; p=002). For the decision tree, the most significant of them were the winter period of the year and the value of the patient's systolic (sys) blood pressure (BP) in the first hours of MI. With the help of a decision tree, four risk classes are identified. The highest risk level (30.2%; group size = 53) was in patients with MI in the winter period and BPsyst≥130 mmHg. The lowest risk level (0.0%, group volume = 45) for the development of AKI was observed for MI in spring, summer and autumn periods and BPsyst˂135.0 mm Hg. With BPsyst≥135 mm Hg. during these periods, the risk of developing AKI increases to 11.6% (69 patients). In winter, with a decrease in BP˂130 mm Hg. the risk of developing AKI is reduced to 4.2% (24 people). The sensitivity of the model was 94.1%; specificity - 70.9%; efficiency - 82.5%. Conclusions. Additions to the known predictors of the development of AKI in MI in males under 60 y.o. were: the winter period, stress, hypertriglyceridemia in the first hours of MI (≥1.8 mmol/l) and a history of peptic ulcer disease. Based on a combination of BP and winter period indicators, a model for assessing the risk of development this complication was built. It allows identifying a risk group for development AKI among patients with MI for follow-up and timely preventive and therapeutic measures.