• Lluís Llauger, Begoña Espinosa, Zubaid Rafique, Stephen Boone, Greg Beuhler, Javier Millán-Soria, Víctor Gil, Javier Jacob, Aitor Alquézar-Arbé, María Campos-Meneses, Rosa Escoda, Josep Tost, Enrique Martín-Mojarro, Alfons Aguirre, María Luisa López-Grima, Julio Núñez, Wilfried Mullens, Pedro Lopez-Ayala, Christian Mueller, Pere Llorens, Frank Peacock, Òscar Miró, and (on behalf of the ICA-SEMES Research Group).
• Emergency Department, Hospital Universitari de Vic, Barcelona.
• Eur J Emerg Med. 2023 Apr 1; 30 (2): 9110191-101.

Background And ImportanceDeterioration of renal function with respect to baseline during an acute heart failure (AHF) episode is frequent, but impact on outcomes is still a matter of debate.ObjectiveTo investigate the association of creatinine deterioration detected at emergency department (ED) arrival and short-term outcomes in patients with AHF.DesignSecondary analysis of a large multipurpose registry.Settings And ParticipantsPatients with AHF were diagnosed in 10 Spanish ED for whom a previous baseline creatinine was available.ExposureDifference between creatinine at ED arrival and at baseline was calculated (∂-creatinine).Outcome Measures And AnalysisPrimary outcome was 30-day all-cause death, and secondary outcomes were inhospital all-cause death, prolonged hospitalization (>7 days) and 7-day postdischarge adverse events. Associations between ∂-creatinine and outcomes were explored using logistic regression by restricted cubic spline (RCS) curves and expressed as odds ratio (OR) with 95% confidence interval (CI), taking ∂-creatinine = 0 mg/dl as reference. Curves were adjusted by age, sex, comorbidities, patient baseline status, chronic treatments, and vitals and laboratory results at ED arrival. Interactions for the primary outcome also were investigated.Main ResultsWe analyzed 3036 patients (median age = 82 years; IQR = 75-87; women = 55%), with ∂-creatinine ranged from -0.3 to 3 mg/dl. The 30-day mortality was 11.6%. Increments of ∂-creatinine were associated with progressive increase in risk of 30-day death, although adjustment attenuated this association: ∂-creatinine of 0.3/1/2/3 mg/dl were, respectively, associated with adjusted OR of 1.41 (1.02-1.95), 1.69 (1.02-2.80), 1.46 (0.56-3.80) and 1.27 (0.27-5.83). Distinctively significant higher risk was found for patients over 80 years old, female, nondiabetic, functionally disabled and on digoxin therapy. With respect to secondary outcomes, inhospital mortality was 8.1%, prolonged hospitalization was 33.6% and 7-day postdischarge adverse event was 9.7%. Inhospital death steadily increased with increments in ∂-creatinine [from 1.50 (1.04-2.17) with ∂-creatinine = 0.3 to 3.78 (0.78-18.3) with ∂-creatinine = 3], as well as prolonged hospitalization did [from 1.41 (1.11-1.77) to 2.24 (1.51-3.33), respectively]. Postdischarge adverse events were not associated with ∂-creatinine.ConclusionWRF detected at ED arrival has prognostic value in AHF, being associated with increased risk of death and prolonged hospitalization. These associations showed different patterns of risk but, remarkably, risk started with increments as low as 0.3 mg/dl.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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