title: Prognostic impact of acute kidney injury in patients with acute decompensated heart failure.
abstract: BACKGROUND
  The relationship between acute kidney injury (AKI) in the acute phase of acute decompensated heart failure (ADHF) and patient outcome has not yet been reported.
  
  
  RESULTS
  Data for 625 patients with ADHF admitted to the intensive care unit were analyzed. No AKI occurred in 281 patients (no AKI) during the first 5 days. The AKI patients were assigned to 3 groups based on the timing: AKI present on admission and stable risk, injury, failure, loss, and endstage (RIFLE) class (stable early AKI; n=125), stepped-up RIFLE class (worsening early AKI; n=49), or AKI that occurred after admission (late AKI; n=170). The AKI patients were grouped into another 3 groups based on severity: class R (risk; n=214), class I (injury; n=73), or class F (failure; n=57). A multivariate logistic regression model found class I, class F, late AKI and worsening early AKI to be independently associated with in-hospital mortality. Kaplan-Meier survival curves showed that the survival rate in any-cause death during 2 years was significantly lower in class I, class F and the worsening early-AKI group, and there were significantly more HF events in class F and the worsening early-AKI group. There were significantly more class I and class F patients in the worsening early-AKI group.
  
  
  CONCLUSIONS
  The presence of AKI on admission, worsening of AKI, and severe AKI (class I or class F) are associated with a poorer prognosis for ADHF patients.
authors.affiliation: Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan. s6042@nms.ac.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shirakabe
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Takuro
authors.initials: T
authors.lastname: Shinada
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tomita
authors.forename: Masafumi
authors.initials: M
authors.lastname: Tsurumi
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushita
authors.forename: Hirokake
authors.initials: H
authors.lastname: Okazaki
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000145:classification* / Q000150:complications*; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors