Impact of infection on decongestion and kidney outcomes in patients with cardiorenal syndrome type 1.

BACKGROUND: Infections are frequent precipitants of acute decompensated heart failure (ADHF) and may alter decongestive trajectories in patients with cardiorenal syndrome type 1 (CRS1), it may reduce diuretic efficacy and increase the risk of kidney injury. However, the impact of infection on decongestion and kidney outcomes in CRS1 remains unclear. METHODS: We conducted a prospective cohort study including 256 patients with CRS1 hospitalized at a tertiary center (2022-2024). Patients were stratified by the presence of infection, defined as clinical suspicion plus antibiotic therapy. The primary outcome was successful decongestion, assessed by symptoms, biomarkers (BNP/CA-125), and POCUS findings. Secondary outcomes included major adverse kidney events at 10 and 30 days (MAKE: death, kidney replacement therapy [KRT], or ≥25% eGFR decline). RESULTS: Seventy-two patients (28.1%) had infection, presenting with higher BNP (13,405 vs. 25,264 pg/mL, p = 0.012) and lower PaO2 (45 vs. 65.5 mmHg, p = 0.019). Furosemide exposure was comparable (600 vs. 580 mg, p = 0.62). Successful decongestion occurred in 61.4% of patients with infection vs. 59.8% without infection (p = 0.83). Infection was not independently associated with decongestion (aOR 1.28, 95% CI 0.65-2.51) or MAKE-30 (aOR 1.26, 95% CI 0.57-2.79). CONCLUSIONS: In CRS1, infection was associated with more severe baseline congestion but did not compromise decongestion rates or increase short-term MAKE. These findings support the notion that achieving decongestion is feasible in patients with ADHF due to infection without an incremental risk of MAKE.