Prediction of mortality using quantification of renal function in acute heart failure

Int J Cardiol. 2015 Dec 15:201:650-7. doi: 10.1016/j.ijcard.2015.08.097. Epub 2015 Aug 11.

Abstract

Background: Renal function, as quantified by the estimated glomerular filtration rate (eGFR), is a predictor of death in acute heart failure (AHF). It is unknown whether one of the clinically-available serum creatinine-based formulas to calculate eGFR is superior to the others for predicting mortality.

Methods and results: We quantified renal function using five different formulas (Cockroft-Gault, MDRD-4, MDRD-6, CKD-EPI in patients<70 years, and BIS-1 in patients≥70 years) in 1104 unselected AHF patients presenting to the emergency department and enrolled in a multicenter study. Two independent cardiologists adjudicated the diagnosis of AHF. The primary endpoint was the accuracy of the five eGFR equations to predict death as quantified by the time-dependent area under the receiver-operating characteristics curve (AUC). The secondary endpoint was the accuracy to predict all-cause readmissions and readmissions due to AHF. In a median follow-up of 374 days (IQR: 221 to 687 days), 445 patients (40.3%) died. eGFR as calculated by all equations was an independent predictor of mortality. The Cockcroft-Gault formula showed the highest prognostic accuracy (AUC 0.70 versus 0.65 for MDRD-4, 0.55 for MDRD-6, and 0.67 for the combined formula CKD-EPI/BIS-1, p<0.05). These findings were confirmed in patients with varying degrees of renal function and in three vulnerable subgroups: women, patients with severe left ventricular dysfunction, and the elderly. The prognostic accuracy for readmission was poor for all equations, with an AUC around 0.5.

Conclusions: Calculating eGFR using the Cockcroft-Gault formula assesses the risk of mortality in patients with AHF more accurately than other commonly used formulas.

Keywords: Acute heart failure; Mortality; Renal function.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology*
  • Heart Failure / complications
  • Heart Failure / diagnosis
  • Heart Failure / mortality*
  • Humans
  • Kidney Function Tests / methods*
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends