Prognostic value of worsening renal function in patients with acute decompensated heart failure with preserved ejection fraction and its association with increased inflammatory state

Objective: The prognostic impact of worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF) with preserved ejection fraction is controversial, and the pathophysiological mechanisms of WRF are not clearly understood. Methods: Fifty-three patients with ADHF with preserved ejection fraction were analyzed. WRF was defined as an increase of ≥ 0.3 mg/dL in the serum creatinine level during the first 5 days of the hospitalization and occurred in 37.7% of the study population. Results: Although baseline C-reactive protein (CRP) levels on admission was similar between patients with and without WRF, patients with WRF had higher 48-h CRP and delta CRP (Δ−CRP = 48-h CRP value − baseline CRP value) levels than those of patients without WRF. Multivariable analysis revealed that the baseline creatinine level and Δ−CRP were the independent risk factors for the development of WRF. The length of hospital stay (LOS) was significantly longer in the WRF group (9.9 ± 10.2 vs. 5.4 ± 2.8 days; P = 0.020). The median follow-up of the study population was 683 days, and the all-cause mortality rate was higher in patients with WRF than those without WRF (40% vs. 9.1%, P = 0.007, respectively). Conclusion: Baseline creatinine levels and Δ−CRP were the independent predictors of WRF. Increased inflammatory status expressed by Δ−CRP is found to be a novel finding for predicting the development of WRF in patients with ADHF with preserved ejection fraction. The presence of WRF was found to be associated with a poorer prognosis, including longer LOS, higher all-cause in-hospital, and all-cause postdischarge mortality.