PROGNOSTIC SIGNIFICANCE OF RISK FACTORS AND BIOMARKERS IN PATIENTS HOSPITALIZED FOR CARDIORENAL SYNDROMES

Abstract

Objective: Cardiorenal syndromes (CRS), involving the heart-kidney cross-talk and the activation of neurohumoral and inflammatory pathways, is an entity characterized by high morbidity and mortality. Our study aimed to evaluate the prognostic role of risk factors and biomarkers in patients ospitalised for CRS. Design and method: In this observational cohort study, 100 consecutive patients ospitalised for CRS were enrolled. Socio-demographic characteristics, personal medical history, and prior medication use were recorded upon admission, and echocardiography was performed. Moreover, an array of blood markers was measured. The endpoint of interest was a composite of death or dialysis dependence at discharge. Results: Patients were classified into two groups; Group 1 (N = 52): discharged being dialysis-independent, Group 2 (N = 48): death/dialysis dependence at discharge. No significant differences were detected in baseline characteristics between the two groups. Group 2 patients used ospit-angiotensin-aldosterone system blockers (RAASb) less often (Group 1: 71.2% vs. Group 2: 41.7%, p = .003) and more frequently presented with oliguria/anuria (Group 1: 28.8% vs. Group 2: 66.7%, p < .001). Group 2 patients had significantly lower hemoglobin, serum albumin, and 25-hydroxy-vitamin D [25(OH)D] (Figure). At the same time, serum phosphate, potassium, N-terminal-pro hormone brain natriuretic peptide, and parathyroid hormone (PTH) were significantly higher in Group 2 patients (Figure). In a multivariate regression analysis, lack of prior RAASb (Odds ratio: 22.0, 95% confidence interval: 2.7–179.5, p = .004) and lower 25(OH)D levels (Odds ratio: 0.90, 95% confidence interval: 0.82–0.99, p = .03) were independently associated with an increased risk of death or dialysis dependence at discharge. 25(OH)D/PTH ratio was the most accurate predictor of the composite endpoint (area under receiver operating characteristics curve: 0.81), with a cutoff of equal or less than 97.9 having a sensitivity and specificity of 79.4% and 70.4%, respectively. Conclusions: Lack of prior RAASb use, high PTH, low 25(OH)D levels, and low 25(OH)D/PTH ratio are associated with a poor prognosis in patients ospitalised for CRS.