Abstract
BackgroundMultiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure. Methods and ResultsWe retrospectively analyzed 787 patients with acute heart failure for the relationship between changes in serum creatinine and biomarkers including brain natriuretic peptide, high sensitivity cardiac troponin I, galectin 3, serum neutrophil gelatinase-associated lipocalin, and urine neutrophil gelatinase-associated lipocalin. WRF was defined as an increase of greater than or equal to 0.3 mg/dL or 50% in creatinine within first 5 days of hospitalization. WRF was observed in 25% of patients. Changes in biomarkers and creatinine were poorly correlated (r ≤ 0.21) and no biomarker predicted WRF better than creatinine. In the multivariable Cox analysis, brain natriuretic peptide and high sensitivity cardiac troponin I, but not WRF, were significantly associated with the 1-year composite of death or heart failure hospitalization. WRF with an increasing urine neutrophil gelatinase-associated lipocalin predicted an increased risk of heart failure hospitalization. ConclusionsBiomarkers were not able to predict WRF better than creatinine. The 1-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, whereas a kidney injury biomarker may prognosticate WRF for heart failure hospitalization.
Highlights
Multiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure
In addition to serial measurements of serum Neutrophil gelatinase-associated lipocalin (NGAL) and urine NGAL for the assessment of acute tubular injury (ATI), other biomarkers including B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I, and galectin 3 (Gal3) were analyzed from stored serum samples.8À10 These biomarkers can reflect different detrimental pathophysiologic processes in cardiorenal syndrome (CRS), including congestion, myocardial damage, myocardial fibrosis, kidney injury and fibrosis, and systemic inflammation.11À16 In this study, we investigated the contribution of different pathophysiologic processes as reflected by biomarkers for the risk of developing WRF, and their prognostic significance in relation to WRF outcomes in patients with acute heart failure (AHF)
Of the 787 patients included, the mean age was 68 § 14 years, 63% were male, 46% had a history of coronary artery disease (CAD), and 44% had a history of diabetes mellitus
Summary
Multiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure. Methods and Results: We retrospectively analyzed 787 patients with acute heart failure for the relationship between changes in serum creatinine and biomarkers including brain natriuretic peptide, high sensitivity cardiac troponin I, galectin 3, serum neutrophil gelatinase-associated lipocalin, and urine neutrophil gelatinase-associated lipocalin. In the multivariable Cox analysis, brain natriuretic peptide and high sensitivity cardiac troponin I, but not WRF, were significantly associated with the 1-year composite of death or heart failure hospitalization. WRF with an increasing urine neutrophil gelatinase-associated lipocalin predicted an increased risk of heart failure hospitalization. The 1-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, whereas a kidney injury biomarker may prognosticate WRF for heart failure hospitalization. (J Cardiac Fail 2021;27:533À541) Key Words: Biomarkers, worsening renal function, acute heart failure, prognosis The 1-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, whereas a kidney injury biomarker may prognosticate WRF for heart failure hospitalization. (J Cardiac Fail 2021;27:533À541) Key Words: Biomarkers, worsening renal function, acute heart failure, prognosis
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