Acute cardiorenal syndrome: baseline comorbidities, biomarkers and prognostic significance

Acute cardiorenal syndrome (ACRS) encompasses a spectrum of disorders that induce acute kidney injury in patients with acute heart failure (AHF). The occurrence of ACRS has been associated with a worse prognosis in the literature and its management often poses a therapeutic challenge.

The purpose of this study is to record the most frequent comorbidities and other clinical, biochemical and imaging parameters of patients with ACRS and to assess the prognostic value associated with its occurrence.

Materials-Methods: We recorded demographic characteristics, baseline comorbidities, left ventricular ejection fraction (LVEF), NT-proBNP, sodium (Na), albumin, troponin (hs-cTnI), glomerular filtration rate (GFR) and systolic blood pressure (SBP) values on admission, creatinine (Cr) values, the peak lateral tricuspid annular systolic velocity (S’ RV) and E/E’ ratio during hospitalization as well as total hospital days and number of deaths in hospitalized AHF patients from February to November 2023. ACRS was defined as an increase in Cr of > 0.3mg/dl or > 1.5 times the baseline value. The patients were separated into two groups based on ACRS occurrence and statistical analysis was performed using IBM-SPSS and values presentation with median and interquartile range.

106/204 hospitalized patients developed ACRS. A statistically significant difference was observed between the two groups in the number of patients with ACRS, chronic kidney disease (CKD), and ischemic cardiomyopathy (ICM). More specifically, patients with CKD had almost 6 times higher risk of developing ACRS during hospitalization compared to those without CKD, while at the same time, patients with ICM had a 2.5 times higher risk for ACRS occurrence. Patients with ACRS also tended to have higher NT-proBNP values (p=0.008) and lower GFR (p<0.001) and sodium values (p=0.016) upon admission. Factors such as sex, age, diastolic and systolic function, co-existence of comorbidities such as hypertension, atrial fibrillation, diabetes mellitus, elevated troponin and admission SBP had no significant effect on the occurrence of ACRS. Finally no statistical significant difference was found between the occurrence of ACRS and death during hospitalization, but patients with ACRS required more hospital days (p<0.001).

Occurrence of ACRS is common among hospitalized patients with AHF. Patients with CKD, ICM, lower values of sodium and GFR as well as increased values of NT-proBNP on admission seem to be the ones to develop more often ACRS. There was no significant association found between gender, admission SBP, and systolic and diastolic function and the incidence of renal function deterioration. Furthermore, no statistical significant difference was found between the occurrence of ACRS and death during hospitalization. However, these patients require more hospital days which increases the risk of hospital-acquired infections and other poor outcomes.

Demographics and comorbidities