Worsening renal function during an episode of acute heart failure and its relation to short- and long-term mortality: associated factors in the Epidemiology of Acute Heart Failure in Emergency Departments-Worsening Renal Function study
Por:
Llauger, L, Jacob, J, Moreno, LA, Aguirre, A, Martin-Mojarros, E, Romero-Carrete, JC, Martinez-Nadal, G, Tost, J, Corominas-Lasalle, G, Roset, A, Cardozo, C, Sunen-Cuquerelle, G, Alarcon, B, Herrera-Mateo, S, Ruibal, JC, Alquezar-Arbe, A, Gil, V, Donee, R, Berenguer, M, Llorens, P, Villanueva-Cutillas, B, Martin-Sanchez, FJ, Herrero, P, Miro, O
Publicada:
1 oct 2020
Resumen:
Objective. To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF).
Methods. Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group.
Results. A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences.
Conclusion. AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency.
Filiaciones:
Llauger, L:
Hosp Univ Vic, Serv Urgencias, Barcelona, Spain
Jacob, J:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Moreno, LA:
Hosp Univ Austral, Serv Urgencias, Buenos Aires, DF, Argentina
Aguirre, A:
Hosp del Mar, Serv Urgencias, Barcelona, Spain
Martin-Mojarros, E:
Hosp Santa Tecla, Serv Urgencias, Tarragona, Spain
Romero-Carrete, JC:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Martinez-Nadal, G:
Univ Barcelona, Hosp Clin, Area Urgencias, Barcelona, Spain
Tost, J:
Hosp Terrassa, Serv Urgencias, Barcelona, Spain
Corominas-Lasalle, G:
Hosp Univ Vic, Serv Urgencias, Barcelona, Spain
Roset, A:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Cardozo, C:
Hosp Univ Austral, Serv Urgencias, Buenos Aires, DF, Argentina
Sunen-Cuquerelle, G:
Hosp del Mar, Serv Urgencias, Barcelona, Spain
Alarcon, B:
Hosp Santa Tecla, Serv Urgencias, Tarragona, Spain
Herrera-Mateo, S:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Ruibal, JC:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Gil, V:
Univ Barcelona, Hosp Clin, Area Urgencias, Barcelona, Spain
Donee, R:
Hosp Terrassa, Serv Urgencias, Barcelona, Spain
Berenguer, M:
Hosp Terrassa, Serv Urgencias, Barcelona, Spain
Llorens, P:
Univ Miguel Hernandez, Hosp Gen Alicante, Serv Urgencias Corta Estancia & Hospitalizac Domi, Alicante, Spain
Villanueva-Cutillas, B:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Martin-Sanchez, FJ:
Univ Complutense, Hosp Clin San Carlos, Serv Urgencias, Madrid, Spain
Herrero, P:
Hosp Univ Cent Asturias, Serv Urgencias, Oviedo, Spain
Miro, O:
Univ Barcelona, Hosp Clin, Area Urgencias, Barcelona, Spain
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