Effect of elevated admission serum creatinine and its worsening on outcome in hospitalized patients with decompensated heart failure

Akhter, Mohammed W.; Aronson, Doron; Bitar, Fahed; Khan, Salman; Singh, Harpreet; Singh, Rajinder; Burger, Andrew J.; Elkayam, Uri

doi:10.1016/j.amjcard.2004.06.041

Cited by 148 publications

(136 citation statements)

References 8 publications

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“…Our study confirms previous reports of the high prevalence of WRF in patients hospitalised for acute HF and its important impact on hospital length of stay and prognosis [9][10][11][13][14][15][16][17]. Our study differs from most of the previous studies, however, in that this was a prospectively designed single center protocol.…”

Section: Patient Characteristicssupporting

confidence: 88%

“…For the group as a whole, the mean duration of hospitalisation was 11 ± 9 days (median, 7 days; IQR, [6][7][8][9][10][11][12][13][14][15]. Patients who developed WRF-Abs-% had a longer mean and median duration of hospital stay: 15 ± 14 days versus 8 ± 7 days (median, IQR: 12, 8-22 days versus 8, 5-14, days; p b 0.001).…”

Section: Clinical and Prognostic Significance Of Wrfmentioning

confidence: 99%

“…Its prevalence increases in patients with more severe HF. More than half of the patients hospitalised for HF have some degree of impairment of renal function, and moderate to severe impairment has been reported in 30-35% of cases [7,[9][10][11][12][13]. Hospitalisation for acute HF is associated with further worsening of renal function (WRF) in 30-50% of patients, depending on the specific definition utilized, and this is associated with prolonged length of hospital stay, increased healthcare costs, increased in-hospital mortality, and higher rates of rehospitalisation and death post-discharge [9][10][11][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…However, these data are derived primarily from retrospective analyses of patients' records from databases of multiple centers and are often limited to patients ≥ 65 years of age [9][10][11]13,15]. With two exceptions [16,17], data on treatment, an important determinant of renal function changes, were not available or utilized.…”

Section: Introductionmentioning

confidence: 99%

“…With two exceptions [16,17], data on treatment, an important determinant of renal function changes, were not available or utilized. The studies also had relatively short follow-up duration, limited to the inhospital course in many studies [13,15,16] and up to 6 months in others [9,10,17]. Lastly, there is no consensus on how best to define WRF, with some studies utilizing the absolute [9][10][11][12][13][15][16][17] and others using relative [14,18] changes in serum creatinine (s-Cr) values.…”

Section: Introductionmentioning

confidence: 99%

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Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Metra

Nodari

Parrinello

et al. 2008

European J of Heart Fail

343

251

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Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a ≥25% and a ≥ 0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%). Results: Patients were followed for 480 ± 363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13-1.81; p = 0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p = 0.002), LV ejection fraction (p = 0.012), furosemide daily dose (p = 0.03) and NYHA class (p = 0.05) on admission. Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.

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Section: Patient Characteristicssupporting

confidence: 88%

Section: Clinical and Prognostic Significance Of Wrfmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Metra

Nodari

Parrinello

et al. 2008

European J of Heart Fail

343

251

View full text Add to dashboard Cite

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Statistical Models and Patient Predictors of Readmission for Heart Failure<subtitle>A Systematic Review</subtitle>

Ross

Mulvey²,

Stauffer³

et al. 2008

Arch Intern Med

319

270

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Background: Readmission after heart failure (HF) hospitalization is an increasing focus for physicians and policy makers, but statistical models are needed to assess patient risk and to compare hospital performance. We performed a systematic review to describe models designed to compare hospital rates of readmission or to predict patients' risk of readmission, as well as to identify studies evaluating patient characteristics associated with hospital readmission, all among patients admitted for HF.

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Impact of Acute Serum Creatinine Elevation in Patients Treated with Nesiritide

Elkayam

Janmohamed

Hatamizadeh

et al. 2009

Clinical Cardiology

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Background:We assessed the effect of increases in serum creatinine on mortality in nesiritide-treated versus control subjects with acute decompensated heart failure (ADHF). Hypothesis: Mortality effect of nesiritide-related increases in serum creatinine differs from that of standard therapies. Methods: Scios Inc., granted unrestricted access to data from all 5 randomized, controlled nesiritide infusion trials completed to date in patients hospitalized with ADHF. We used 2 different definitions of acute serum creatinine increase: >0.3 mg/dL and >0.5 mg/dL within 30 days of study enrollment and determined 30-day mortality risk for nesiritide-treated versus control subjects utilizing each definition. Results: A total of 1,270 subjects participated in the 5 trials. A >0.3 mg/dL increase in serum creatinine was associated with a significant increase in mortality risk in control subjects, (hazard ratio [HR]: 3.47, 95% confidence interval [CI]: 1.49-8.09) but not in nesiritide-treated subjects (HR: 1.65, 95% CI: 0.90-3.05).Results were similar for a >0.5 mg/dL increase (control HR: 5.12, 95% CI: 2.09-12.57 and nesiritide HR: 1.77, 95% CI: 0.90-3.51). In subjects with >0.3 mg/dL and >0.5 mg/dL increases in serum creatinine, respectively, the 30-day mortality odds ratios for nesiritide relative to control were 0.73 (95% CI: 0.29-1.93) and 0.52 (95% CI: 0.17-1.63) using a stratified Mantel-Haenszel analysis. Conclusions: The impact of increased serum creatinine on mortality was attenuated in nesiritide-treated patients compared to control, suggesting that the mechanism and clinical significance of increases in serum creatinine associated with nesiritide treatment may differ from those associated with standard therapies. Further investigation is warranted.

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Effect of elevated admission serum creatinine and its worsening on outcome in hospitalized patients with decompensated heart failure

Cited by 148 publications

References 8 publications

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Statistical Models and Patient Predictors of Readmission for Heart Failure<subtitle>A Systematic Review</subtitle>

Impact of Acute Serum Creatinine Elevation in Patients Treated with Nesiritide

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