Acute Cardiorenal Syndrome Type 1 in Patients With Congestive Heart Failure Exacerbations Is Not an Indicator of Poor Outcome and Increased Mortality

BACKGROUND Over one million patients are hospitalized each year with acute decompensated heart failure (ADHF) in the US. Approximately 20% to 40% of them will develop acute cardiorenal syndrome type 1 (ACRS1) via multiple mechanisms. METHODS From January 2010 to December 2010, 197 patients were diagnosed with ADHF. Initial N-terminal pro-brain natriuretic peptide (NT-pro BNP), creatinine levels throughout hospital stay, use of invasive mechanical ventilation, length of hospital stay and death were assessed for each patient. ACRS1 was diagnosed when an increase of creatinine > 0.3 mg/dL from baseline was noted during hospital stay. We sought to investigate whether presence of ACRS1 is associated with increased length of stay, need for mechanical ventilation and increased in-hospital mortality in patients admitted with ADHF. RESULTS Total of 61 (31%) patients experienced ACRS1. Mean hospital stay for ACRS1 patients was 8.43 ± 6.28 days while for non-ACRS1 was 5.06 ± 4.19 (P < 0.0001). Twenty-eight (14%) patients required invasive mechanical ventilation (11 non-ACRS1 vs. 17 ACRS1). ACRS1 was associated with more frequent use of invasive ventilation (odd ratio 3.45, CI 1.52 - 7.79, P = 0.003). Fifteen (8%) patients expired (8 non-ACRS1 vs. 7 ACRS1). There was no difference in mortality between groups (odd ratio 2.07, CI 0.72 - 6.00, P = 0.18). CONCLUSIONS Development of ACRS1 was not associated with increased incidence of in-hospital mortality, but it prolonged hospital stay and need for mechanical ventilation.