title: Prognostic value of transient and sustained increase in in-hospital creatinine on outcomes of patients admitted with acute coronary syndrome.
abstract: A history of renal insufficiency or increased creatinine level on admission is associated with poor outcomes in patients with acute coronary syndrome (ACS). This study sought to determine whether in-hospital worsening of renal function, either transient or sustained, is an independent risk factor for 6-month mortality in patients admitted with ACS. A total of 1,417 patients admitted with ACS from June 2000 to May 2003 were reviewed. Patients were classified into 3 groups. Group I included patients with an increase in creatinine during hospitalization of <or=0.5 mg/dl. Group II included patients with an increase in creatinine of >0.5 mg/dl that resolved by discharge. Group III included patients with an increase in creatinine of >0.5 mg/dl that did not resolve. The primary end point was 6-month mortality from any cause. Patients in groups II and III had higher 6-month mortality rates (27% and 23%, respectively; both p<0.001) compared with patients in group I (7.4%). After adjustment for known risk factors, a transient increase in creatinine remained a significant independent predictor of 6-month mortality (odds ratio 2.07, 95% confidence interval 1.14 to 3.76), although a sustained increase in creatinine showed a trend (odds ratio 1.58, 95% confidence interval 0.68 to 3.70). In conclusion, independent of a history of renal insufficiency or increased admission creatinine, in-hospital worsening of renal function is an important risk factor for 6-month mortality in patients admitted with ACS. Furthermore, return to baseline function by discharge does not protect against this risk. These findings have implications for management of these high-risk patients.
authors.affiliation: University of Michigan Hospital, Ann Arbor, Michigan, USA. raklatch@yahoo.com
authors.forename: Rakesh
authors.initials: R
authors.lastname: Latchamsetty
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: Eva
authors.initials: E
authors.lastname: Kline-Rogers
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Richard F
authors.initials: RF
authors.lastname: Otten
authors.forename: Troy M
authors.initials: TM
authors.lastname: LaBounty
authors.forename: Michael S
authors.initials: MS
authors.lastname: Emery
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
mesh_terms: D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012107:Research Design; D012307:Risk Factors; D016019:Survival Analysis; D013577:Syndrome; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine