Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure?
| Autor: | Barbara Piovanelli, Valentina Lazzarini, Valentina Carubelli, Silvia Bugatti, Christopher L. Edwards, Luca Bettari, Marco Metra, Beth A. Davison, Hengrui Sun, Livio Dei Cas, Gad Cotter, Carlo Lombardi |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty acute heart failure Renal function Kidney chemistry.chemical_compound Internal medicine medicine Humans In patient Intensive care medicine Survival rate renal function acute heart failure Aged Retrospective Studies Aged 80 and over Heart Failure Creatinine business.industry renal function Follow up studies Retrospective cohort study Middle Aged Prognosis medicine.disease Survival Rate chemistry Heart failure Acute Disease Multivariate Analysis Cardiology Female Risk of death Cardiology and Cardiovascular Medicine business Biomarkers Follow-Up Studies |
| Zdroj: | Circulation: Heart Failure. 5:54-62 |
| ISSN: | 1941-3297 1941-3289 |
| DOI: | 10.1161/circheartfailure.111.963413 |
| Popis: | Background— Worsening renal function (WRF), traditionally defined as an increase in serum creatinine levels ≥0.3 mg/dL, is a frequent finding in patients with acute heart failure (AHF) and has been associated with poorer outcomes in some but not all studies. We hypothesized that these discrepancies may be caused by the interaction between WRF and congestion in AHF patients. Methods and Results— We measured serum creatinine levels on a daily basis during the hospitalization and assessed the persistence of signs of congestion at discharge in 599 consecutive patients admitted at our institute for AHF. They had a postdischarge mortality and mortality or AHF readmission rates of 13% and 43%, respectively, after 1 year. Patients were subdivided into 4 groups according to the development or not of WRF and the persistence of ≥1 sign of congestion at discharge. Patients with WRF and no congestion had similar outcomes compared with those with no WRF and no congestion, whereas the risk of death or of death or AHF readmission was increased in the patients with persistent congestion alone and in those with both WRF and congestion (hazard ratio, 5.35; 95% confidence interval, 3.0–9.55 at univariable analysis; hazard ratio, 2.44; 95% confidence interval, 1.24–4.18 at multivariable analysis for mortality; hazard ratio, 2.14; 95% confidence interval, 1.39–3.3 at univariable analysis; and hazard ratio, 1.39; 95% confidence interval, 0.88–2.2 at multivariable analysis for mortality and rehospitalizations). Conclusions— WRF alone, when detected using serial serum creatinine measurements, is not an independent determinant of outcomes in patients with AHF. It has an additive prognostic value when it occurs in patients with persistent signs of congestion. |
| Databáze: | OpenAIRE |
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