{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:05:08Z","timestamp":1786125908053,"version":"build-2736575974"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Secretaria de Salud Jalisco y el Consejo Nacional de Ciencia, Humanidades y Tecnolog\u00eda CONAHCYT.","award":["1"],"award-info":[{"award-number":["1"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective cohort study including 256 patients with CRS1 hospitalized at a tertiary center (2022\u20132024). 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 \u226525% eGFR decline).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-two patients (28.1%) had infection, presenting with higher BNP (13,405 vs. 25,264 pg\/mL, p\u2009=\u20090.012) and lower PaO\n                      <jats:sub>2<\/jats:sub>\n                      (45 vs. 65.5 mmHg, p\u2009=\u20090.019). Furosemide exposure was comparable (600 vs. 580 mg, p\u2009=\u20090.62). Successful decongestion occurred in 61.4% of patients with infection vs. 59.8% without infection (p\u2009=\u20090.83). Infection was not independently associated with decongestion (aOR 1.28, 95% CI 0.65\u20132.51) or MAKE-30 (aOR 1.26, 95% CI 0.57\u20132.79).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355608","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:23:34Z","timestamp":1786123414000},"page":"e0355608","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of infection on decongestion and kidney outcomes in patients with cardiorenal syndrome type 1"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2786-6667","authenticated-orcid":true,"given":"Jonathan S.","family":"Ch\u00e1vez-I\u00f1iguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose J.","family":"Zaragoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronaldo Escoto-","family":"Del Toro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itzel","family":"Fong-Maravilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Navarro-Blackaller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7094-6964","authenticated-orcid":true,"given":"Ram\u00f3n","family":"Medina-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro Mart\u00ednez","family":"Gallardo-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz","family":"Alcantar-Vallin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan A.","family":"G\u00f3mez-Fregoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Mendoza-Gait\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Arizaga-N\u00e1poles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan B.","family":"Ivey-Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Garc\u00eda-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"issue":"1","key":"pone.0355608.ref001","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/s41572-020-0151-7","article-title":"Acute heart failure","volume":"6","author":"M Arrigo","year":"2020","journal-title":"Nat Rev Dis Primers"},{"issue":"3","key":"pone.0355608.ref002","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4103\/nmj.NMJ_63_19","article-title":"Association between Common Etiologies and Precipitants of Acute Decompensated Heart Failure","volume":"60","author":"EJ Ogbemudia","year":"2019","journal-title":"Niger Med J"},{"issue":"18","key":"pone.0355608.ref003","first-page":"6459","article-title":"Correlation of mortality with Pro-BNP and precipitating factors of acute heart failure in patients presenting to a medical emergency of tertiary care hospital: an observational study from north India","volume":"26","author":"MS Bhatia","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"4","key":"pone.0355608.ref004","first-page":"362","article-title":"Pneumonia and inflammation in acute decompensated heart failure: A registry-based analysis of 1939 patients","volume":"7","author":"A Jobs","year":"2018","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"issue":"3","key":"pone.0355608.ref005","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.cardfail.2013.12.007","article-title":"Noncardiovascular death, especially infection, is a significant cause of death in elderly patients with acutely decompensated heart failure","volume":"20","author":"T Ueda","year":"2014","journal-title":"J Card Fail"},{"issue":"2","key":"pone.0355608.ref006","first-page":"253","article-title":"S\u00edndrome cardiorrenal: clasificaci\u00f3n, fisiopatolog\u00eda, diagn\u00f3stico y tratamiento. Una revisi\u00f3n de las publicaciones m\u00e9dicas","volume":"92","author":"JS Ch\u00e1vez-I\u00f1iguez","year":"2022","journal-title":"Arch Cardiol Mex"},{"issue":"10","key":"pone.0355608.ref007","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1002\/ejhf.3423","article-title":"Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm?","volume":"26","author":"J Biegus","year":"2024","journal-title":"Eur J Heart Fail"},{"key":"pone.0355608.ref008","article-title":"Quantification and treatment of congestion in heart failure: A clinical and pathophysiological overview","author":"R de la Espriella","year":"2021","journal-title":"Nefrologia (Engl Ed)"},{"issue":"1","key":"pone.0355608.ref009","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12882-021-02637-y","article-title":"The Effect in renal function and vascular decongestion in type 1 cardiorenal syndrome treated with two strategies of diuretics, a pilot randomized trial","volume":"23","author":"JS Ch\u00e1vez-I\u00f1iguez","year":"2022","journal-title":"BMC Nephrol"},{"issue":"6","key":"pone.0355608.ref010","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1038\/s41581-023-00683-3","article-title":"Sepsis-associated acute kidney injury: Consensus report of the 28th Acute Disease Quality Initiative workgroup","volume":"19","author":"A Zarbock","year":"2023","journal-title":"Nat Rev Nephrol"},{"issue":"1","key":"pone.0355608.ref011","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1186\/s13054-015-1017-3","article-title":"Loop diuretics in acute heart failure: Beyond the decongestive relief for the kidney","volume":"19","author":"A Palazzuoli","year":"2015","journal-title":"Crit Care"},{"issue":"19","key":"pone.0355608.ref012","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/j.jacc.2008.07.051","article-title":"Cardiorenal syndrome","volume":"52","author":"C Ronco","year":"2008","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"pone.0355608.ref013","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s11897-015-0273-5","article-title":"Current approach to decongestive therapy in acute heart failure","volume":"12","author":"P Martens","year":"2015","journal-title":"Curr Heart Fail Rep"},{"issue":"1","key":"pone.0355608.ref014","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/cc11454","article-title":"Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1)","volume":"17","author":"JA Kellum","year":"2013","journal-title":"Crit Care"},{"issue":"9","key":"pone.0355608.ref015","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"AS Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"pone.0355608.ref016","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1159\/000363725","article-title":"Clinical trial endpoints in acute kidney injury","volume":"127","author":"FT Billings","year":"2014","journal-title":"Nephron Clin Pract"},{"issue":"9","key":"pone.0355608.ref017","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1007\/s00134-024-07560-y","article-title":"Recommendations for clinical trial design in acute kidney injury from the 31st acute disease quality initiative consensus conference. 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