Abstract 12956: Prediction of True Worsening Renal Failure Which Were Associated With Poor Long-Term Outcome in Patients With Acute Heart Failure. The Importance of Cardiac Biomarkers Based on Cardio Renal Syndrome.

Background: Whether or not the definition of a worsening renal function (WRF) is adequate for the evaluation of acute renal failure in patients with acute heart failure (AHF) is unclear. The biomarker for the prediction of true WRF, which is associated with a poor prognosis, is also obscured. Methods and Results: The total 1,083 patients with AHF were analyzed. A WRF, indicated by a change in serum creatinine ≥ 0.3 mg/ml within the first 5 days, occurred in 360 patients, while no WRF, indicated by a change < 0.3 mg/dl in 723 patients. Acute kidney injury (AKI) on admission was defined based on the ratio of the serum creatinine value recorded on admission to the baseline creatinine value, and placed into groups based on the degree of AKI: no-AKI (n=751), Class R (risk; n=193), Class I (injury; n=41), or Class F (failure; n=98). The patients were assigned to another four groups: no-WRF/no-AKI (n=512), no-WRF/AKI (n=211), WRF/no-AKI (n=239) and WRF/AKI (n=121). A multivariate Cox regression model found that no-WRF/AKI and WRF/AKI were independently associated with 365-days mortality (hazard ratio [HR]: 1.916; 95%confidence interval [CI]: 1.234-2.974, and HR: 3.622; 95%CI: 2.332-5.624). Kaplan-Meier survival curves showed that the rate of 365-days mortality was significantly poorer in the no-WRF/AKI and WRF/AKI groups than in the WRF/No-AKI and no-WRF/no-AKI group, and in Class I and Class F than in Class R and the no-AKI group. We next analyzed 283 AHF patients. Their biomarkers were measured within 30 minutes of admission. Patients were assigned to the non-WRF (n=143), no-WRF/AKI (n=38), WRF/no-AKI (n=53) and WRF/AKI (n=47) groups. The multivariate logistic regression model indicated that the predictive biomarker for the WRF/AKI group was the serum heart-type fatty acid-binding protein (s-HFABP) level (odds ratio: 9.235; 95%CI: 3.101-27.509). S-HFABP demonstrated the optimum balance between sensitivity and specificity (80.9%, 76.5%; area under the curve=0.831) at 22.4 ng/ml for the WRF/AKI group. Conclusions: The presence of AKI on admission, especially Class I and Class F status, is associated with a poor prognosis despite the lack of an WRF within the first 5 days. Cardiac biomarkers, the s-HFABP, might predict the development of true WRF (WRF/AKI) in AHF patients. [ABSTRACT FROM AUTHOR]