Cardiorenal anemia syndrome as an independent predictor of inhospital complications in acute coronary syndrome

Aim. To evaluate the clinical significance of cardiorenal anemia syndrome (CRAS) in patients with acute coronary syndrome (ACS) as an independent predictor of following inhospital complications: acute kidney injury (AKI), clinically significant bleeding, and inhospital mortality. Material and methods. This retrospective study included 210 patients with ACS. Patients were classified into four phenotypes based on the presence of anemia and renal dysfunction on admission. AKI was diagnosed using the KDIGO criteria, and bleeding was diagnosed using the BARC scoring system (types 2-5). To assess the prognostic significance of CRAS, we used multivariate regression analysis adjusting for the following parameters: age, sex, ACS type, Killip class, and percutaneous coronary intervention. Results. The incidence of CRAS was 14,8% (31/210 patients). AKI was reported in 24,8% of patients in the general sample. In the CRAS group, the incidence of AKI was significantly higher than in patients with other phenotypes (51,6% vs 20,1%; p<0,001). In the multivariate model, CRAS was associated with a fourfold increase in the risk of AKI (adjusted odds ratio 4,03; 95% confidence interval 1,69-9,62; p=0,0017). The incidence of inhospital bleeding was also higher with СRAS (22,6% vs 7,8%; p=0,011). However, multivariate analysis did not confirm an independent association (p=0,083). Inhospital mortality in the general sample was 5,2% and did not demonstrate an independent association with CRAS. Conclusion. CRAS is independently associated with an increased AKI risk in patients with ACS. Identification of this phenotype upon admission can be considered as an additional tool for early risk stratification and optimization of inhospital management of comorbid patients.