Systemic inflammation plays a pivotal role in the pathogenesis and prognosis of cardiac surgery–associated acute kidney injury (CSA-AKI). The Systemic Inflammation Response Index (SIRI) has emerged as a novel biomarker reflecting immune inflammatory balance. This study aimed to explore the association between SIRI and in-hospital mortality among patients with CSA-AKI. Data of CSA-AKI patients were extracted from the MIMIC-IV 3.1 database. SIRI was calculated and divided into 3 tertiles. Restricted cubic spline (RCS) models were used to assess nonlinear associations between SIRI and mortality. Multivariate logistic regression models were constructed to evaluate the independent relationship between SIRI and outcomes after adjusting for potential confounders. A total of 5394 patients with CSA-AKI were included. Patients in the medium SIRI tertile (1.27–3.06) demonstrated the lowest mortality (1.3%) compared to the low (2.0%) and high (3.1%) tertiles. RCS analysis revealed a significant U-shaped association between SIRI levels and in-hospital mortality risk ( P for nonlinearity < .001). Below the inflection point (SIRI = 1.6899), mortality risk tended to decrease with increasing SIRI, while above this threshold, each 1-unit increase in SIRI was significantly associated with a 10% higher risk of in-hospital mortality (OR 1.10, 95% CI 1.03–1.16, P = .001) after adjustment. SIRI demonstrated a U-shaped association with mortality among patients with CSA-AKI, indicating that both immune suppression and excessive inflammation are detrimental. SIRI may serve as a simple, readily available biomarker to reflect immune homeostasis and assist in postoperative risk stratification. Further prospective studies are warranted to validate these findings.

Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a common complication with substantial morbidity and mortality. Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist (MRA), has demonstrated cardiorenal benefits in experimental studies; however, its perioperative renal safety after cardiac surgery remains unclear. This retrospective cohort study included 1,211 consecutive adults undergoing cardiac surgery from September 2024 to May 2025. Patients were categorized into finerenone, spironolactone, and no-MRA groups. The primary outcome was in-hospital acute kidney injury (AKI) according to Kidney Disease: Improving Global Outcomes criteria. Multivariable logistic regression, inverse probability of treatment weighting (IPTW), and subgroup analyses were performed. Among 1,211 patients, 458 received finerenone, 413 received spironolactone, and 340 received no MRA therapy. Compared with no MRA, finerenone was not associated with reduced AKI risk (adjusted odds ratio [aOR] 0.73, 95% confidence interval [CI] 0.42–1.30; P=0.288). However, compared with spironolactone, finerenone was associated with lower risks of AKI (aOR 0.37, 95% CI 0.23–0.59; P<0.001) and major adverse kidney events (aOR 0.45, 95% CI 0.29–0.70; P<0.001), with consistent findings in IPTW analyses. Perioperative finerenone was not associated with reduced AKI compared with no MRA therapy but showed more favorable renal outcomes than spironolactone after cardiac surgery. These findings warrant confirmation in prospective randomized trials.

Background: The incidence and predictors of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) during the same hospitalization remain poorly characterized, particularly in Asian populations. Methods: This single-center retrospective study included 164 consecutive patients who underwent PCI and transfemoral TAVR during the same hospitalization at Beijing Anzhen Hospital between June 2018 and October 2023. The primary objective was to evaluate the incidence of MACCE, and logistic regression analyses were used to identify its predictors. Results: Among 164 patients, the mean age was 73.9 ± 7.2 years, and 57.9% were male. Device success was 97.6% and procedural success was 89.6%. MACCE occurred in 28 patients (17.1%) within the index hospitalization or 30 days after discharge. Independent predictors of MACCE were lower baseline left ventricular ejection fraction (LVEF; OR = 0.955, 95% CI 0.920–0.992; p = 0.017) and mixed aortic stenosis and regurgitation (AS + AR; OR = 6.360, 95% CI 1.035–38.993; p = 0.038). Conclusions: A single-hospitalization PCI and TAVR strategy appeared feasible and was associated with acceptable short-term clinical outcomes in carefully selected Chinese candidates, with lower baseline LVEF and mixed AS and AR as independent predictors of MACCE. The observed clinical outcomes should be interpreted descriptively because of the lack of a contemporaneous comparator group; large-scale prospective studies are needed to further evaluate the safety and clinical benefit of this “one-stop” paradigm.