Potential Utility of Cardio-Renal Biomarkers For Prediction and Prognostication of Worsening Renal Function in Acute Heart Failure: Cardio-Renal Biomarkers and WRF in AHF.

Abstract Background: Multiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure (AHF). Methods and Results: We retrospectively analyzed 787 AHF patients for the relationship between changes in serum creatinine and biomarkers including brain natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), galectin 3, serum neutrophil gelatinase-associated lipocalin (NGAL) and urine NGAL. WRF was defined as an increase of ≥ 0.3 mg/dl or 50% in creatinine within first 5 days of hospitalization. WRF was observed in 25% of patients. Changes in biomarkers and creatinine were poorly correlated (r ≤ 0.21) and no biomarker predicted WRF better than creatinine. In the multivariable Cox analysis, BNP and hscTnI, but not WRF, were significantly associated with the one-year composite of death or HF hospitalization. WRF with an increasing urine NGAL predicted an increased risk of HF hospitalization. Conclusions: Biomarkers were not able to predict WRF better than creatinine. One-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, while a kidney injury biomarker may prognosticate WRF for HF hospitalization.