AIMS In acute heart failure (AHF), relationships between changes in B-type natriuretic peptide (BNP) and worsening renal function (WRF) and its prognostic implications have not been fully determined. We investigated the relationship between WRF and a decrease in BNP with in-hospital and 1-year mortality in AHF. METHODS AND RESULTS The Acute Kidney Injury NGAL Evaluation of Symptomatic heart faIlure Study (AKINESIS) was a prospective, international, multicentre study of AHF patients. Severe WRF (sWRF) was a sustained increase of ≥44.2 μmol/L (0.5 mg/dL) or ≥50% in creatinine, non-severe WRF (nsWRF) was a non-sustained increase of ≥26.5 μmol/L (0.3 mg/dL) or ≥50% in creatinine, and WRF with clinical deterioration was nsWRF with renal replacement therapy, inotrope use, or mechanical ventilation. Decreased BNP was defined as a ≥30% reduction in the last measured BNP compared to admission BNP. Among 814 patients, the incidence of WRF was not different between patients with or without decreased BNP (nsWRF: 33% vs. 31%, P = 0.549; sWRF: 11% vs. 9%, P = 0.551; WRF with clinical deterioration: 8% vs. 10%, P = 0.425). Decreased BNP was associated with better in-hospital and 1-year mortality regardless of WRF, while WRF was associated with worse outcomes only in patients without decreased BNP. In multivariate Cox regression analysis, decreased BNP, sWRF, and WRF with clinical deterioration were significantly associated with 1-year mortality. CONCLUSIONS Decreased BNP was associated with better in-hospital and long-term outcomes. WRF was only associated with adverse outcomes in patients without decreased BNP.

中文翻译：

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B型利钠肽趋势预测急性心力衰竭中肾功能恶化的临床意义。

目的在急性心力衰竭（AHF）中，B型利钠肽（BNP）的变化与肾功能恶化（WRF）之间的关系及其对预后的影响尚未完全确定。我们调查了WRF与AHF住院期间和1年死亡率与BNP降低之间的关系。方法和结果对有症状的心力衰竭研究（AKINESIS）进行的急性肾脏损伤NGAL评价是一项针对AHF患者的前瞻性国际多中心研究。严重的WRF（sWRF）持续≥≥44.2μmol/ L（0.5 mg / dL）或≥50％肌酐，非严重的WRF（nsWRF）≥≥26.5μmol/ L（0.3 mg / dL）或肌酐中的≥50％，临床恶化的WRF为经肾脏替代疗法，使用正性肌力药物或机械通气的nsWRF。BNP降低的定义为与入院BNP相比，最后一次测得的BNP降低≥30％。在814例患者中，BNP降低或未降低的患者之间WRF的发生率无差异（nsWRF：33％vs.31％，P = 0.549; sWRF：11％vs. 9％，P = 0.551;具有临床恶化的WRF： 8％对10％，P = 0.425）。不论WRF如何，BNP降低均与住院和1年死亡率较高相关，而仅在BNP降低的患者中，WRF与较差的预后相关。在多因素Cox回归分析中，BNP，sWRF和WRF降低以及临床恶化与1年死亡率显着相关。结论BNP降低与更好的住院和长期预后相关。WRF仅与BNP降低的患者不良预后相关。