Worsening renal function developed in 27% of hospitalized heart failure patients and was associated with significantly higher in-hospital mortality (ARR 7.5; 95% CI 2.9-19.3).
Cohort (n=1,004)
Yes
Does the development of worsening renal function impact in-hospital outcomes in patients hospitalized with heart failure?
Worsening renal function occurs in over a quarter of hospitalized heart failure patients and is strongly associated with increased in-hospital mortality, complications, and prolonged length of stay.
Effect estimate: ARR 7.5 (95% CI 2.9-19.3)
OBJECTIVES: The goal of this study was to determine the prevalence of worsening renal function (WRF) among hospitalized heart failure (HF) patients, clinical predictors of WRF, and hospital outcomes associated with WRF. BACKGROUND: Impaired renal function is associated with poor outcomes among chronic HF patients. METHODS: Chart reviews were performed on 1,004 consecutive patients admitted for a primary diagnosis of HF from 11 geographically diverse hospitals. Cox regression model analysis was used to identify independent predictors for WRF, defined as a rise in serum creatinine of >0.3 mg/dl (26.5 micromol/l). Bivariate analysis was used to determine associations of development of WRF with outcomes (in-hospital death, in-hospital complications, and length of stay). RESULTS: Among 1,004 HF patients studied, WRF developed in 27%. In the majority of cases, WRF occurred within three days of admission. History of HF or diabetes mellitus, admission creatinine > or =1.5 mg/dl (132.6 micromol/l), and systolic blood pressure >160 mm Hg were independently associated with higher risk of WRF. A point score based on these characteristics and their relative risk ratios predicted those at risk for WRF. Hospital deaths (adjusted risk ratio ARR 7.5; 95% confidence intervals CI 2.9, 19.3), complications (ARR 2.1; CI 1.5, 3.0), and length of hospitalizations >10 days (ARR 3.2, CI 2.2, 4.9) were greater among patients with WRF. CONCLUSIONS: Worsening renal function occurs frequently among hospitalized HF patients and is associated with significantly worse outcomes. Clinical characteristics available at hospital admission can be used to identify patients at increased risk for developing WRF.
Forman et al. (Thu,) conducted a cohort in Heart failure (n=1,004). Worsening renal function vs. No worsening renal function was evaluated on In-hospital death (ARR 7.5, 95% CI 2.9-19.3). Worsening renal function developed in 27% of hospitalized heart failure patients and was associated with significantly higher in-hospital mortality (ARR 7.5; 95% CI 2.9-19.3).