Prognostic significance of creatinine increases during an acute heart failure admission in patients with and without residual congestion

Metra, M. et al. (2018) Prognostic significance of creatinine increases during an acute heart failure admission in patients with and without residual congestion. Circulation: Heart Failure, 11(5), e004644. (doi: 10.1161/CIRCHEARTFAILURE.117.004644) (PMID:29748350)

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Background: The importance of a serum creatinine increase, traditionally considered worsening renal function (WRF), during admission for acute heart failure has been recently debated, with data suggesting an interaction between congestion and creatinine changes. Methods and Results: In post hoc analyses, we analyzed the association of WRF with length of hospital stay, 30-day death or cardiovascular/renal readmission and 90-day mortality in the PROTECT study (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function). Daily creatinine changes from baseline were categorized as WRF (an increase of 0.3 mg/dL or more) or not. Daily congestion scores were computed by summing scores for orthopnea, edema, and jugular venous pressure. Of the 2033 total patients randomized, 1537 patients had both available at study day 14. Length of hospital stay was longer and 30-day cardiovascular/renal readmission or death more common in patients with WRF. However, these were driven by significant associations in patients with concomitant congestion at the time of assessment of renal function. The mean difference in length of hospital stay because of WRF was 3.51 (95% confidence interval, 1.29–5.73) more days (P=0.0019), and the hazard ratio for WRF on 30-day death or heart failure hospitalization was 1.49 (95% confidence interval, 1.06–2.09) times higher (P=0.0205), in significantly congested than nonsignificantly congested patients. A similar trend was observed with 90-day mortality although not statistically significant. Conclusions: In patients admitted for acute heart failure, WRF defined as a creatinine increase of ≥0.3 mg/dL was associated with longer length of hospital stay, and worse 30- and 90-day outcomes. However, effects were largely driven by patients who had residual congestion at the time of renal function assessment.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Metra, M., Cotter, G., Senger, S., Edwards, C., Cleland, J. G., Ponikowski, P., Cursack, G. C., Milo, O., Teerlink, J. R., Givertz, M. M., O’Connor, C. M., Dittrich, H. C., Bloomfield, D. M., Voors, A. A., and Davison, B. A.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Circulation: Heart Failure
Publisher:Lippincott Williams and Wilkins
ISSN (Online):1941-3297
Published Online:10 May 2018
Copyright Holders:Copyright © 2018 American Heart Association, Inc.
First Published:First published in Circulation: Heart Failure 11(5): e004644
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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