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

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.

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