Abstract 17974: Prognostic Impact After Acute Kidney Injury in Patients with Acute Heart Failure: An evaluation of the RIFLE Criteria
Background: The clinical course and the outcome of acute heart failure (AHF) are known to correlate with renal dysfunction. However, the evaluation of renal dysfunction, especially acute kidney injury (AKI), has not yet been standardized. This study, therefore, investigated the relationship between the short term and long term prognosis of AHF and AKI using the risk, injury, failure, and end stage (RIFLE) criteria.
Methods and Results: This study analyzed seven hundred ten patients with AHF who were admitted to the intensive care unit. The most severe RIFLE classifications during hospitalization were adopted to assess the patient outcome. The AHF patients were assigned to no AKI (n=244), Class R (risk; n=259), Class I (injury; n=106), and Class F (failure; n=101). This study evaluated the relationships between the RIFLE classifications and in-hospital mortality, cardiovascular death and HF events including cardiovascular death, and readmission to the hospital for HF within 2 years. The results of the multivariate logistic regression model for in-hospital mortality found that the specific factors were Class I (p=0.005, hazard ratio: 4.01; 95% CI: 1.51-10.69) and Class F (p<0.001, hazard ratio: 10.64; 95% CI: 4.21-26.90). Furthermore, Class I and Class F were independently associated with cardiovascular death (Class I p=0.006, hazard ratio: 2.49; 95% CI: 1.31-4.75, Class F p<0.001, hazard ratio: 5.42; 95% CI: 2.84-10.35) and Class F were independently associated with HF events (p<0.001, hazard ratio: 3.09; 95% CI: 1.76-5.43). The Kaplan-Meier survival curves showed the prognosis including cardiovascular death to be significantly poorer among the patients with Class I and Class F in comparison to no-AKI and Class R (p<0.001, Log-Rank test), and the prognosis including HF events to be significantly poorer among the patients with Class F in comparison to no-AKI, Class R and Class I (p<0.001, Log-Rank test).
Conclusions: The presence of severe AKI (Class I and F) was found to be independently associated with both short-term and long-term mortality in patients with AHF, however, mild AKI (Class R) and no AKI were not associated with those events. The RIFLE criteria should therefore be developed into a clinically applicable and standardized method for AHF patients.
- © 2011 by American Heart Association, Inc.