Syndrome cardio-rénal de type 1: prévalence et facteurs associés chez des patients hospitalisés pour insuffisance cardiaque décompensée dans 2 hopitaux de référence à Yaoundé

Diane Laure TIWA MELI (tiwadiane@gmail.com)
Médecine interne, FMSB, Université Yaoundé 1
July, 2015
 

Abstract

Introduction: Despite the significant progress made in the management of Decompensated Heart Failure (DHF) during the last century, this entity is still associated with a considerable morbidity and mortality. To date, numerous factors have been identified as being responsible for this poor outcome. Among those, type 1 cardio-renal syndrome (CRS-1) is seen by many authors as the worst factor associated with a bad prognosis for patients with DHF. CRS-1 is defined as an acute kidney injury (AKI) resulting from an episode of DHF, acute coronary syndrome, cardiogenic shock, or cardiac surgery-associated low cardiac output syndrome. In Africa, there is a paucity of data available on this subject. Recent studies revealed discrepancies related to the prevalence of CRS1 and its associated factors between African and Caucasian populations.
Objective: The aim of this study was to determine the prevalence of CRS-1 and its associated factors among adult subjects hospitalized for DHF in 2 major Hospitals in Yaoundé.
Methods: We carried out a cross-sectional and analytical study between January and March 2015 in the Cardiology Units of the Yaoundé General hospital and Central Hospital. Consenting adults admitted for decompensated heart failure were included. We excluded subjects with a history of chronic kidney disease, or any other potential cause of AKI, or who died before the collection of the second blood sample. At inclusion (Day 0), after obtaining the informed consent, relevant clinical data was obtain from history and medical records. Blood sample were then collected for serum creatinine, sodium, potassium, and uric acid. Electrocardiographic and cardiac ultrasound parameters were equally recorded. Serum creatinine levels were also measured on day 2 and day 5 for the diagnosis of CRS-1. Participants were then followed till hospital discharge to evaluate mortality and length of hospital stay. The diagnosis of DHF was made using the European Society of Cardiology criteria. CRS-1 was defined as an increase in serum creatinine > 3mg/L from admission, or a significant increase in serum creatinine on Day0 that subsequently declined during hospitalization with the treatment of DHF, in the absence of other AKI risk factors. Data were analyzed using SPSS 20.0 software. Statistical significance was set at p<0.05. This study was approved by the Institutional Ethics and Research Committee of the Faculty of Medicine and Biomedical Sciences.
Results: A total of 32 subjects were enrolled with males representing 56.3%. The median age was 69.50 years with a minimum of 21 and a maximum of 99. The most frequent etiologies were high blood pressure (21.9%), valve diseases (18.8%), and dilated cardiomyopathies (18.8%). On biology, 23.8%(n=5) had anemia, 46,9% (n=15) had hyponatremia, and 59.4% (n=19) had hyperuricemia. As per echocardiographic findings, 40.6% (n=13) had a systolic dysfunction. We found a CRS1 prevalence of 37.5% of whom 58.33% met the 3rd criteria. A serum creatinine ≥14mg/L on enrolment was significantly associated with type 1 cardio-renal syndrome (p=0.025, CI: 0.03-0.080). We did not find any association between CRS1 and socio-demographic characteristics, comorbidities, the etiology or the severity of the heart failure.
Conclusion: We found a high prevalence of type 1 cardio-renal syndrome in an adult population hospitalized for decompensated heart failure in 2 major referral hospitals in in the city of Yaoundé. A high serum creatinine on admission was significantly associated with type 1 cardio-renal syndrome. We therefore recommend that larger cohort studies be carried out in order to throw more light on the real importance of this clinical entity and its associated factors in our milieu.
Key words: prevalence, type 1 cardiorenal syndrome, decompensated heart failure, associated factors, Yaoundé.


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