Is Worsening Renal Function an Ominous Prognostic Sign in Patients with Acute Heart Failure? The Role of Congestion and Its Interaction with Renal Function.
Circ Heart Fail. 2011 Dec 13;
Authors: Metra M, Davison B, Bettari L, Sun H, Edwards C, Lazzarini V, Piovanelli B, Carubelli V, Bugatti S, Lombardi C, Cotter G, Dei Cas L
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 hypothesised 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 post-discharge mortality and mortality or AHF readmission rates of 13% and 43%, respectively, after one 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 to 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 [HR], 95% confidence intervals [CI] 5.35, 3.0-9.55 at univariable and 2.44, 1.24-4.18 at multivariable analysis for mortality and HR,95%CI 2.14, 1.39-3.3 at univariable and 1.39, 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.
PMID: 22167320 [PubMed - as supplied by publisher]