title: Single baseline serum creatinine measurements predict mortality in critically ill patients hospitalized for acute heart failure.
abstract: BACKGROUND
  Acute heart failure (AHF) is a leading cause of death in critically ill patients and is often accompanied by significant renal dysfunction. Few data exist on the predictive value of measures of renal dysfunction in large cohorts of patients hospitalized for AHF.
  
  
  METHODS
  Six hundred and eighteen patients hospitalized for AHF (300 male, aged 73.3 ± 10.3 years, 73% New York Heart Association Class 4, mean hospital length of stay 12.9 ± 7.7 days, 97% non-ischaemic AHF) were included in a retrospective single-centre data analysis. Echocardiographic data, serum creatinine/urea levels, estimated glomerular filtration rate (eGFR), and clinical/laboratory markers were recorded. Mean follow-up time was 2.9 ± 2.1 years. All-cause mortality was recorded, and univariate/multivariate analyses were performed.
  
  
  RESULTS
  Normal renal function defined as eGFR > 90 mL/min/1.73 m2was noted in only 3% of AHF patients at baseline. A significant correlation of left ventricular ejection fraction with serum creatinine levels and eGFR (allP< 0.002) was noted. All-cause mortality rates were 12% (90 days) and 40% (at 2 years), respectively. In a multivariate model, increased age, higher New York Heart Association class at admission, higher total cholesterol levels, and lower eGFR independently predicted death. Patients with baseline eGFR < 30 mL/min/1.73 m2had an exceptionally high risk of death (odds ratio 2.80, 95% confidence interval 1.52-5.15,P= 0.001).
  
  
  CONCLUSIONS
  In a large cohort of patients with mostly non-ischaemic AHF, enhanced serum creatinine levels and reduced eGFR independently predict death. It appears that patients with eGFR < 30 mL/min/1.73 m2have poorest survival rates. Our data add to mounting data indicating that impaired renal function is an important risk factor for non-survival in patients hospitalized for AHF.
authors: Department of Nephrology and Intensive Care MedicineCharité University MedicineBerlinGermany; Department of Intensive Care Medicine, InselspitalBern University HospitalBernSwitzerland.
authors: Joerg C
authors: JC
authors: Schefold
authors: Department of CardiologyGeneral and Teaching Hospital CeljeCeljeSlovenia; Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia.
authors: Mitja
authors: M
authors: Lainscak
authors: Department of Internal Medicine General Hospital Murska Sobota Murska Sobota Slovenia.
authors: Lea Majc
authors: LM
authors: Hodoscek
authors: Deptartment of Cardiology, Inselspital Bern University Hospital Bern Switzerland.
authors: Stefan
authors: S
authors: Blöchlinger
authors: Center for Stroke Research BerlinCharité Universitätsmedizin BerlinBerlinGermany; Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany.
authors: Wolfram
authors: W
authors: Doehner
authors: Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany; Department of Cardiology and Center for Innovative TrialsUniversity of GöttingenGöttingenGermany.
authors: Stephan
authors: S
authors: von Haehling
keywords: Cardiac failure; Cardiac shock; Cardiorenal syndrome; ICU