Serum Albumin level can predict Cardiorenal Syndrome type -1

Abstract

Background: Cardiorenal Syndrome Type1 (CRS1), defined as increase in serum Creatinine (Cr) of ≥ 0.3 mg/dl from the baseline, occurs in approximately 25 - 40% of patients admitted with Acute Decompensated Heart Failure (ADHF) and presents a myriad of challenges in diagnosis and management. Hypoalbuminemia is independently associated with ADHF and acute kidney injury.
Aim: To study if serum albumin level can predict the CRS1.
Method: Retrospective chart review including the renal function and hospital course of all ADHF patients were performed. Patients were excluded if there was insufficient laboratory data, admission serum creatinine > 2.5 mg/dl and recent use of radio contrast and if the reason of admission was deemed to be other than ADHF.
Results: Over two years, 201 patients (mean age_68.1, 48% male) were enrolled. Despite the standard dose of furosemide about 43% patients developed CRS-1. S. Alb cut-off level of 3.4 g/dl was determined from ROC curve; patients with S.Alb < 3.4 g/dl (group1, n = 90) were compared with patients with higher S.Alb (group 2, n = 111). Group 1 had more elder patients and worse renal function on admission (P = 0.02 and P = 0.012 respectively). Group 1 was found to be at a higher risk of developing CRS1 during hospitalization (OR = 4.48; 95% CI 2.46 to 8.14; P = < 0.0001; adjusted OR for age = 2.7; 95% CI 1.2 to 6.9; P = 0.03; adjusted OR for < 30 ml/min creatinine clearance on admission = 1.7; 95% CI 1.1 to 4.0; P = 0.04) and also had significantly longer hospital stay (13.3 ± 17.5 versus 7.2 ± 5.3; P = 0.003).
Conclusion: Hypoalbuminemia (S.Alb < 3.4g/dl) predicts CRS1 and a complicated hospital course in patients with ADHF.