Effect of the Creatinine Excretion Rate Index, a Marker of Sarcopenia, on Prediction of Intracranial Hemorrhage in Patients With Advanced Heart Failure and a Continuous-Flow Left Ventricular Assist Device.

Abstract

BACKGROUND:

Sarcopenia is characterized by progressive loss of skeletal muscle and has frequently been associated with poor clinical outcomes in patients with advanced heart failure (HF). The urinary creatinine excretion rate (CER) index is an easily measured marker of muscle mass, but its predictive capacity for mortality and cerebrovascular events has not been investigated in patients with a continuous-flow implantable left ventricular assist device (CF-iLVAD).Methods and Results:We retrospectively reviewed 147 patients (mean [±SD] age 43.7±12.5 years, 106 male) who underwent CF-iLVAD implantation between April 2011 and June 2019. CER indices in 24-h urine samples before CF-iLVAD implantation were determined. Over a median follow-up of 2.3 years, there were 10 (6.8%) deaths and 43 (29.3%) cerebrovascular events. Patients were divided into 2 groups (low and high CER index) according to the median CER index in men and women (i.e., 13.71 and 12.06 mg·kg-1·day-1, respectively). Mortality and intracranial hemorrhage rates after CF-iLVAD implantation were significantly higher in the low than high CER index group (mortality 12.3% vs. 1.4% [P<0.01]; intracranial hemorrhage 23.3% vs. 8.1% [P=0.01]). Multivariate Cox proportional hazard models revealed that a low CER index was an independent predictor of intracranial hemorrhage in patients receiving a CF-iLVAD (hazard ratio 3.63; 95% confidence interval 1.43-9.24; P<0.01).

CONCLUSIONS:

A low preoperative CER index is an independent, non-invasive predictor of intracranial hemorrhage after CF-iLVAD implantation.

• Authors: Keiichiro Iwasaki, Osamu Seguchi, Shunsuke Murata, Kunihiro Nishimura, Koichi Yoshitake, Nobuichiro Yagi, Yasumori Sujino, Eiji Anegawa, Hiroki Mochizuki, Kensuke Kuroda, Seiko Nakajima, Takuya Watanabe, Masanobu Yanase, Satsuki Fukushima, Tomoyuki Fujita, Junjiro Kobayashi, Hiroshi Ito, Norihide Fukushima
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 84 Issue 6 Pg. 949-957 (05 25 2020) ISSN: 1347-4820 [Electronic] Japan
• PMID: 32269201 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Creatinine

Topics

• Adult
• Biomarkers (urine)
• Creatinine (urine)
• Databases, Factual
• Female
• Heart Failure (complications, mortality, physiopathology, therapy)
• Heart-Assist Devices
• Humans
• Intracranial Hemorrhages (diagnostic imaging, etiology, mortality)
• Male
• Middle Aged
• Prosthesis Implantation (adverse effects, instrumentation, mortality)
• Renal Elimination
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sarcopenia (complications, mortality, urine)
• Time Factors
• Treatment Outcome
• Ventricular Function, Left