Prognostic value of acute cardiorenal syndrome in patients with acute cardiac pathology

Abstract

Background. Acute kidney injury (AKI) as a manifestation of acute cardiorenal syndrome is a pathological condition with a poor prognosis. Aim. To assess the prevalence and prognostic value of AKI in patients with acute decompensation of chronic heart failure (ADCHF) with a reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) or acute coronary syndrome (ACS), to identify predictors of AKI. Materials and methods. In a prospective study included 863 patients, of which 141 with ADCHF, 446 - non-ST-elevation acute coronary syndromes (NSTE-ACS) and 276 - ST-segment elevation myocardial infarction (STEMI). AKI was diagnosed according to KDIGO recommendations. The end point was defined as death from cardiovascular causes. Result. During the follow-up from 1 to 37 months (median follow-up was 18 months) for patients with ADCHF in 24,8% an endpoint was reported. For patients with ACS, the observation time ranged from 1 day to 14 months (median follow-up was 12 months), in 4,3% - NSTE-ACS, 10,9% - STEMI the end point was recorded. AKI developed in 14,8% of patients with ADCHF HFpEF and 11,2% ADCHF HFrEF, in 23,1% - STEMI and 21,4% - NSTE-ACS. AKI increases the risk of death from cardiovascular causes in patients with ADCHF HFrEF (OR 95% 98,750 (11,158-873,976), р<0,001) and STEMI (OR 95% 5,395 (2,451-11,878), p<0,001), but did not increase the risk of an endpoint occurrence in patients with ADCHF HFpEF (OR 95% 1,875 (0,221-15,930), р=0,565) and NSTE-ACS (OR 95% 1,199 (0,421-3,412), р=0,734). The multivariate analysis revealed risk factors for the development of AKI in patients with ADCHF HFrEF: high albuminuria (AU) from 30 mg/l (OR 95% 5,763 (1,338-24,819), р=0,019), GFR<45 ml/min initially at admission to hospital (OR 95% 76,593 (1,193-36,446), p=0,031), age>75 years (OR 15,933 (1,020-248,856), р=0,048). In patients with STEMI: age>75 years (OR 95% 3,248 (1,476-7,146), p=0,003), female gender (OR 95% 2,321 (1,190-4,526), p=0,013), acute heart failure (AHF) Killip IV (OR 95% 10,334 (1,777-60,110), p=0,009). Risk factors for the development of AKI in patients with NSTE-ACS: age>75 years (OR 95% 1,761 (1,051-2,949), р=0,032), PCI on RCA (OR 95% 2,565 (1,193-5,517), р=0,016). Conclusion. In patients with ADCHF HFrEF and STEMI development AKI is associated with a poor prognosis, but does not affect the prognosis of patients with ADCHF HFpEF and NSTE-ACS. AKI in patients with ADCHF HFrEF can be predicted using predictors: GFR<45 ml/min, AU more than 30 mg/l and age>75 years. In patients with STEMI, the predictors of AKI were age>75 years, female gender, AHF Killip IV, and in patients with NSTE-ACS age>75 years, PCI on RCA.