A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure

作者：Testani Jeffrey M^*; Damman Kevin; Brisco Meredith A; Chen Susan; Laur Olga; Kula Alexander J; Tang W H Wilson; Parikh Chirag

来源：Journal of Cardiac Failure, 2014, 20(12): 912-919.

DOI：10.1016/j.cardfail.2014.08.008

• Cardiorenal syndrome
• BNP
• blood urea nitrogen to creatinine ratio
• decompensated heart failure

Background: Differentiating heart failure (HF) induced renal dysRD) from intrinsic kidney disease is challenging. It has been demonstrated that biomarkers such as B-type natriuretic peptide (BNP) or the blood urea nitrogen to creatinine ratio (BUN/creat) can identify high- vs low-risk RD. Our objective was to determine if combining these biomarkers could further improve risk stratification and clinical phenotyping of patients with RD and HF. %26lt;br%26gt;Methods and Results: A total of 908 patients with a discharge diagnosis of HF were included. Median values were used to define elevated BNP (%26gt; 1296 pg/mL) and BUN/creat ( %26gt; 17). In the group without RD, survival was similar regardless of BNP and BUN/creat (n = 430, adjusted P = .52). Similarly, in patients with both a low BNP and BUN/creat, RD was not associated with mortality (n = 250, adjusted hazard ratio [HR] = 1.0, 95% confidence interval [CI] 0.6-1.6, P = .99). However, in patients with both an elevated BNP and BUN/creat those with RD had a cardiorenal profile characterized by venous congestion, diuretic resistance, hypotension, hyponatremia, longer length of stay, greater inotrope use, and substantially worse survival compared with patients without RD (n = 249, adjusted HR = 1.8, 95% CI 1.2-2.7, P = .008, P interaction = .005). %26lt;br%26gt;Conclusions: In the setting of decompensated HF, the combined use of BNP and BUN/creat stratifies patients with RD into groups with significantly different clinical phenotypes and prognosis.

• 出版日期2014-12