PROGRESSIVE HYPONATREMIA DURING HEART FAILURE TREATMENT PROVIDES ADDITIONAL LONG-TERM PROGNOSTIC INFORMATION TO HEMOCONCENTRATION IN PATIENTS ADMITTED WITH ACUTE DECOMPENSATED HEART FAILURE

Backgrounds: Elevated blood urea nitrogen to creatinine ratio (BUN/Cr), a surrogate for renal neurohumoral activation, is a marker of mortality in patients with heart failure. Acute kidney injury (AKI) during heart failure treatment is also associated with poor outcome in patients admitted with acute decompensated heart failure (ADHF). However, there is little information available on the long-term prognostic significance of AKI, relating to BUN/Cr in ADHF patients. Methods and Results: We studied 305 consecutive ADHF patients discharged with survival. We defined high BUN/Cr as top tertile at the admission (>24.0). AKI during ADHF treatment was defined according to AKI Network criteria (stage 1, ≥0.3mg/dl absolute or 1.5- to 2.0-fold relative increase in serum creatinine level (s-Cr); stage 2, >2- to 3-fold increase in s-Cr; stage 3, >3-fold increase in s-Cr or s-Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.2±3.2 yrs, 69 patients had cardiovascular death (CVD). At multivariate Cox analysis, BUN/Cr (p=0.01) and AKI (p=0.0005) were significantly associated with CVD, independently of age, systolic blood pressure, serum sodium and hemoglobin levels and estimated glomerular filtration rate. Irrespective of high or low BUN/Cr, patients with stage 2 or 3 AKI (adjusted hazard ratio(HR): 6.9 (95%CI 1.5 to 30.4) in high BUN/Cr group, 2.9 (95%CI 1.1 to 7.7) in low BUN/Cr group) had the significant increased CVD risk, compared to patients with no AKI. On the other hand, although patients with stage 1 AKI had the significant increased CVD risk (adjusted HR: 3.8 (95%CI 1.5 to 9.7) in high BUN/Cr group, there was no significant difference in CVD risk between patients with stage 1 AKI (adjusted HR: 0.6 (95%CI 0.3 to 1.2) and no AKI in low BUN/Cr group. Conclusion: Moderate to severe AKI during heart failure treatment would provide the additional long-term prognostic information to BUN/Cr in ADHF patients.

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Effects of early diuretic response to carperitide in acute decompensated heart failure treatment: A single-center retrospective study

PLoS ONE ◽

10.1371/journal.pone.0199263 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0199263 ◽

Cited By ~ 1

Author(s):

Yoshitaka Okuhara ◽

Masanori Asakura ◽

Kohei Azuma ◽

Yoshiyuki Orihara ◽

Koichi Nishimura ◽

...

Keyword(s):

Heart Failure ◽

Retrospective Study ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Single Center ◽

Heart Failure Treatment ◽

Failure Treatment ◽

Diuretic Response

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Abstract 12660: Model of End-Stage Liver Disease Excluding INR (MELD-XI) Scoring System Provides the Long-Term Prognostic Information in Patients Admitted With Acute Decompensated Heart Failure, Regardless of Reduced or Preserve Left Ventricular Ejection Fraction

Circulation ◽

10.1161/circ.130.suppl_2.12660 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Takahisa Yamada ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

Yusuke Iwasaki ◽

...

Keyword(s):

Heart Failure ◽

Scoring System ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Prognostic Information ◽

Ventricular Ejection Fraction ◽

Cox Analysis

Backgrounds: Liver dysfunction has a prognostic impact on the outcome of patients with advanced heart failure. A model of end-stage liver disease excluding INR (MELD-XI) is a robust scoring system of liver dysfunction, and a high score has been shown to be associated with poor prognosis in patients with heart failure. However, there is little information available on the long-term prognostic significance of MELD-XI score in patients admitted with acute decompensated heart failure (ADHF), relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF). Methods and Results: We studied 303 consecutive patients admitted with ADHF and discharged with survival (HFrEF(LVEF<50%); n=163, HFpEF;n=140). MELD-XI score was calculated by the following formula: 5.11[[Unable to Display Character: ･]]ln(bilirubin)+11.79[[Unable to Display Character: ･]]ln(creatinine)+9.44. During a follow-up period of 5.0±4.3 yrs, 75 patients had cardiovascular death (CVD). Receiver-operator curve analysis revealed that MELD-XI score of 12 was a fair discriminator for CVD (AUC 0.704 (95%CI 0.635-0.772), p<0.0001; sensitivity 67% and specificity 62%). In HFrEF group, MELD-XI score was significantly independently associated with CVD (p=0.0037) at multivariate Cox analysis, and patients with high MELD-XI score (≥12) had a higher risk of CVD than those with low MELD score (46% vs 24%, p=0.0038, hazard ratio: 2.20 (95%CI 1.27-3.79)). In HFpEF group, MELD-XI score was also significantly independently associated with CVD (p=0.005) at multivariate Cox analysis, and patients with high MELD-XI score (≥12) had a higher risk of CVD (34% vs 8%, p<0.0001, hazard ratio: 6.25 (95%CI 2.59-15.05)). Conclusion: A MELD-XI scoring system would provide the long-term prognostic information in patients admitted with ADHF, regardless of HFrEF or HFpEF.

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Abstract 12854: Uric Acid In-hospital Change Provides the Additional Long-Term Prognostic Information to Acute Kidney Injury in Patients Admitted for Acute Decompensated Heart Failure

Circulation ◽

10.1161/circ.132.suppl_3.12854 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Takahisa Yamada ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

Yusuke Iwasaki ◽

...

Keyword(s):

Heart Failure ◽

Uric Acid ◽

Acute Decompensated Heart Failure ◽

Kidney Injury ◽

Fold Increase ◽

Decompensated Heart Failure ◽

Cvd Risk ◽

Prognostic Information ◽

Stage 1

Backgrounds: Acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in patients admitted with acute decompensated heart failure (ADHF). In patients with ADHF,increased uric acid (UA) level is also a prognostic marker, but there is no information available on the long-term prognostic significance of UA in-hospital change, relating to AKI in patients admitted for ADHF. Methods and Results: We studied 237 patients admitted with ADHF and discharged with survival. The measurements of serum UA and creatinine (Cr) levels were repeated during hospitalization, and the change of UA was obtained by subtracting the value at admission or discharge from the maximum value. AKI was defined according to AKI Network criteria (stage 1, ≥0.3mg/dl absolute or 1.5-to 2.0-fold relative increase in Cr; stage 2, >2- to 3-fold increase in Cr; stage 3, >3-fold increase in Cr or Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.3±3.3 yrs, 59 patients had cardiovascular death (CVD). At multivariate Cox analysis, UA change (p=0.02) and stage 2 or 3 AKI (p=0.01) were significantly associated with CVD, independently of age, systolic blood pressure, serum sodium, hemoglobin, UA and Cr levels, although stage 1 AKI showed no significant association with CVD. Patients with both higher degree of UA change (top quartile:≥4.4 mg/dl) and stage 2 or 3 AKI had a significant increased CVD risk, compared to patients with either higher UA change or stage 2 or 3 AKI (75% vs 34%, p=0.006, hazard ratio 3.8[95%CI 1.4-8.6]). Furthermore, patients with either higher UA change or stage 2 or 3 AKI also had a significant increased CVD risk, compared to patients with none of these two variables (34% vs 19%, p=0.01, hazard ratio 2.0[95%CI 1.1-3.5]). Conclusion: Uric acid in-hospital change could provide the additional long-term prognostic information to moderate to severe AKI in patients admitted for ADHF.

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Abstract 12975: A New Systemic Inflammation-nutrition Index Provides the Additional Long-term Prognostic Information to Ahead Score in Patients With Admitted for Acute Decompensated Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.12975 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takahisa Yamada ◽

Testuya Watanabe ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Atrial Fibrillation ◽

Systemic Inflammation ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Prognostic Information ◽

Heart Failure Patients ◽

Ahead Score

Background: Comorbidities are associated with poor clinical outcome in heart failure patients. AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes in patients with acute decompensated heart failure (ADHF). On the other hand, systemic inflammation plays a critical role in the outcomes of heart failure. Malnutrition is also associated with poor outcome in heart failure patients. It has been recently reported that advanced lung cancer inflammation index (ALI), which is calculated as body mass index х serum albumin / neutrophil to lymphocyte ratio, is an independent prognostic marker in several types of cancer. We sought to investigate the prognostic value of the combination of AHEAD score and ALI in ADHF patients. Methods and Results: We studied 263 patients admitted for ADHF and discharged with survival. At the discharge, we obtained ALI and AHEAD score (range 0-5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus). During a follow-up period of 5.0±4.2 yrs, 67 patients had cardiovascular death (CVD). At multivariate Cox analysis, AHEAD score and ALI were significantly independently associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure and serum sodium level. The patients with both greater AHEAD score (≥median value=3) and lower ALI (≤median value=42.3) had a significantly increased risk of CVD than those with either and none of them (45% vs 24% vs 13%, p<0.0001, respectively). Conclusion: ALI would provide the additional long-term prognostic information to AHEAD score in patients with ADHF.

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