RENAL AND CARDIAC BIOMARKERS IN PREDICTING MORTALITY IN PATIENTS WITH ACUTE HEART FAILURE: AN INTEGRATED APPROACH

Abstract

Acute heart failure (AHF) is one of the leading causes of hospitalizations in adults and the elderly, representing a significant global public health problem. Its complex pathophysiology, associated with the interaction between cardiac and renal dysfunction, hinders accurate risk stratification and appropriate clinical management. The combined use of cardiorenal biomarkers has proven to be a promising tool for predicting mortality and early readmissions. This study aimed to review the recent scientific literature on the prognostic accuracy of the main cardiac and renal biomarkers—especially BNP, NT-proBNP, troponin T, cystatin C, and NGAL—in patients hospitalized for AHF. This is an integrative review based on articles published between 2015 and 2024 in the PubMed, Scielo, and Web of Science databases. It was observed that the concomitant elevation of BNP > 1000 pg/mL and cystatin C > 1.3 mg/L was associated with up to 3.2 times higher risk of in-hospital mortality, regardless of ejection fraction. Early renal biomarkers such as NGAL demonstrated superior sensitivity to creatinine for the detection of subclinical acute kidney injury, allowing for early therapeutic adjustments. It is concluded that an integrated approach between internal medicine, cardiology, and nephrology, with the combined use of cardiorenal biomarkers, optimizes prognostic assessment and favors individualized decision-making, reducing adverse outcomes and length of hospital stay.