Background: The importance of a serum creatinine increase, traditionally considered worsening renal function (WRF), during admission for acute heart failure has been recently debated, with data suggesting an interaction between congestion and creatinine changes.

Methods and Results: In post hoc analyses, we analyzed the association of WRF with length of hospital stay, 30-day death or cardiovascular/renal readmission and 90-day mortality in the PROTECT study (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function). Daily creatinine changes from baseline were categorized as WRF (an increase of 0.3 mg/dL or more) or not. Daily congestion scores were computed by summing scores for orthopnea, edema, and jugular venous pressure. Of the 2033 total patients randomized, 1537 patients had both available at study day 14. Length of hospital stay was longer and 30-day cardiovascular/renal readmission or death more common in patients with WRF. However, these were driven by significant associations in patients with concomitant congestion at the time of assessment of renal function. The mean difference in length of hospital stay because of WRF was 3.51 (95% confidence interval, 1.29–5.73) more days (P=0.0019), and the hazard ratio for WRF on 30-day death or heart failure hospitalization was 1.49 (95% confidence interval, 1.06–2.09) times higher (P=0.0205), in significantly congested than nonsignificantly congested patients. A similar trend was observed with 90-day mortality although not statistically significant.

Conclusions: In patients admitted for acute heart failure, WRF defined as a creatinine increase of ≥0.3 mg/dL was associated with longer length of hospital stay, and worse 30- and 90-day outcomes. However, effects were largely driven by patients who had residual congestion at the time of renal function assessment.

Clinical Trial Registration : URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458.

背景：急性肌力衰竭入院期间，通常认为血清肌酐增加的重要性（传统上认为是肾功能恶化）的数据已引起争议，数据表明充血和肌酐变化之间存在相互作用。

方法和结果：在事后分析中，我们在PROTECT研究（选择性A1腺苷受体拮抗剂Rolofylline的安慰剂对照随机研究：患有急性失代偿性心力衰竭和体力超负荷住院的患者，以评估对充血和肾功能的治疗效果。每日从基线的肌酐变化归类为WRF（增加0.3 mg / dL或更多）。每天的充血评分是通过计算正气，水肿和颈静脉压的总和得出的。在2033名随机分组的患者中，有1537名患者在研究第14天都可以使用。WRF患者的住院时间较长，而30天心血管/肾脏再入院或死亡更为常见。然而，这些是由在评估肾功能时伴有充血的患者中的显着相关性驱动的。由于WRF，住院时间的平均差异为多了3.51天（95％置信区间为1.29-5.73）（P = 0.0019），并且在30天死亡或心力衰竭住院期间，WRF的危险比是高拥挤患者，而不是严重拥挤患者，其风险比高1.49倍（95％置信区间，1.06-2.09）（P = 0.0205）。90天死亡率观察到类似趋势，尽管无统计学意义。

结论：在接受急性心力衰竭的患者中，WRF定义为肌酐增加≥0.3 mg / dL与住院时间延长和30天和90天病情恶化有关。然而，影响主要是由在肾功能评估时残留充血的患者引起的。

临床试验注册：URL：https://www.clinicaltrials.gov。唯一标识符：NCT00328692和NCT00354458。