Elevated serum C-reactive protein levels as a predictive indicator for subsequent renal impairment in patients with acute heart failure

Renal impairment is often observed in acute heart failure (HF), which is an independent prognostic factor. It is important to identify high-risk patients, who need close follow-up and intensive care for renal protection. This study was conducted to identify the factors associated with the subsequent occurrence of HF-related renal dysfunction in patients, who were admitted to the hospitals due to acute HF symptoms. We evaluated 254 consecutive patients with acute HF. HF-related renal dysfunction was defined when highest serum creatinine level was greater than 1.2 mg/dl and the serum creatinine level increased by more than 50% compared with the baseline value during the admission. Forty patients with acute HF (16%) had subsequent renal dysfunction after admission. Elevated serum C-reactive protein (CRP) levels (≥ 5 mg/dl, odds ratio 2.51, p = 0.008 by univariate analysis, odds ratio 2.43, p = 0.019 by multivariate analysis) during the first week after admission and over-reduction of body weight (≥ 4.5 kg, odds ratio 2.68, p = 0.005 by univariate analysis, odds ratio 2.53, p = 0.010 by multivariate analysis) by acute HF treatment were significantly associated with this phenomenon. Patients with high CRP levels (≥ 5 mg/dl) during the first week after admission showed a significantly greater elevation of serum creatinine levels as compared to the levels before admission than those with low CRP levels (< 5 mg/dl). In conclsion, higher serum levels of CRP could predict the subsequent renal impainnent in patients admitted with the worsening of HF symptoms.