title: Urinary cadmium levels predict mortality of patients with acute heart failure.
abstract: BACKGROUND
  Acute heart failure (AHF) is a serious condition that is associated with increased mortality in critically ill patients. Previous studies indicated that environmental exposure to cadmium increases mortality of general populations. However, the relationship of cadmium exposure and mortality is unclear for AHF patients.
  
  
  METHODS
  A total of 153 patients with AHF in intensive care units (ICUs) met the inclusion criteria and were followed up for 6 months. Demographic data, AHF etiology, hematological and biochemical data, and hospital mortality were recorded. The scores of two predictive systems (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II]) for mortality in critically ill patients were calculated, and urinary cadmium levels were recorded.
  
  
  RESULTS
  At the end of the follow-up period, the mortality rate was 24.8%. The survivors (n=115) had higher urinary cadmium levels on day 1 (D1UCd) of ICU admission than non-survivors (n=38). A multiple linear regression analysis revealed a positive correlation between D1UCd and acute kidney injury, but a negative correlation between D1UCd and the level of serum albumin. A multivariate Cox analysis indicated that D1UCd was an independent predictor of mortality in AHF patients. For each increment of 1 μg of D1UCd, the hazard ratio for ICU mortality was 1.20 (95% confidence interval [CI]: 1.09-1.32,P<0.001). The area under the receiver operating characteristic curve for D1UCd was 0.84 (95% CI: 0.78-0.91), better than the values for the SOFA and APACHE II systems.
  
  
  CONCLUSIONS
  The D1UCd may serve as a single predictor of hospital mortality for AHF patients in the ICU. Because of the high mortality and smaller sample size, more investigations are required to confirm these observations and elucidate the underlying mechanisms.
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.affiliation: Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC; Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC.
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Kuan-Hsing
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
keywords: acute heart failure; cadmium; hospital mortality; intensive care unit