title: Early serum creatinine changes and outcomes in patients admitted for acute heart failure: the cardio-renal syndrome revisited.
abstract: BACKGROUND
  The changes in renal function that occurred in patients with acute decompensated heart failure (ADHF) are prevalent, and have multifactorial etiology and dissimilar prognosis. To what extent the prognostic role of such changes may vary according to the presence of renal insufficiency at admission is not clear. Accordingly, we sought to determine whether early creatinine changes (ΔCr) (admission to 48-72 hours) had an effect on 1-year mortality relative to the presence of renal insufficiency at admission.
  
  
  METHODS
  We included 705 consecutive patients admitted with the diagnosis of ADHF. Admission renal insufficiency was defined as serum creatinine ≥1.4mg/dl (A-RIcr) or estimated glomerular filtration rate <60ml/min/1.73m2(A-RIGFR). Appropriate survival regression techniques were used.
  
  
  RESULTS
  The mean age was 72.9±11.4 years and 51.2% were males. Patients with admission renal insufficiency (24.7% and 42.8% for A-RIcr and A-RIGFR, respectively) had higher prevalence of extreme values in ΔCr in either direction (increasing/decreasing). At 1-year follow-up, 114 (16.2%) deaths were registered. The multivariable analysis showed a significant interaction between admission renal insufficiency and ΔCr ( p=0.004 and p=0.019 for A-RIcr and A-RIGFR, respectively). In the presence of renal insufficiency, the continuum of ΔCr followed a positive and almost linear relationship with mortality risk. Conversely, in patients without renal insufficiency, those changes adopted a 'J-shape' trajectory with increased mortality at both ends of the curve distribution.
  
  
  CONCLUSIONS
  In patients with ADHF the effect of ΔCr on 1-year mortality varied according to its magnitude and the presence of admission renal insufficiency. There was a graded-association with mortality when renal insufficiency was present on admission.
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Julio
authors: J
authors: Núñez
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Sergio
authors: S
authors: Garcia
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Eduardo
authors: E
authors: Núñez
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Clara
authors: C
authors: Bonanad
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Vicent
authors: V
authors: Bodí
authors: 2 Servicio de Cardiología, Hospital de Manises, Valencia, Spain.
authors: Gema
authors: G
authors: Miñana
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Enrique
authors: E
authors: Santas
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: David
authors: D
authors: Escribano
authors: 3 Servicio de Cardiología, Hospital Universitari Germas Trias i Pujol, Badalona, Spain.
authors: Antonio
authors: A
authors: Bayes-Genis
authors: 4 Servicio de Cardiología, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain.
authors: Domingo
authors: D
authors: Pascual-Figal
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Francisco J
authors: FJ
authors: Chorro
authors: 1 Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors: Juan
authors: J
authors: Sanchis
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D059347:Cardio-Renal Syndrome / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D002423:Cause of Death / Q000639:trends; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: absolute creatinine changes; acute decompensated heart failure; mortality; renal failure; worsening renal function