| Related Articles |
Prediction of mortality using quantification of renal function in acute heart failure.
Int J Cardiol. 2015 Aug 11;201:650-657
Authors: Weidmann ZM, Breidthardt T, Twerenbold R, Züsli C, Nowak A, von Eckardstein A, Erne P, Rentsch K, de Oliveira MT, Gualandro D, Maeder MT, Gimenez MR, Pershyna K, Stallone F, Haas L, Jaeger C, Wildi K, Puelacher C, Honegger U, Wagener M, Wittmer S, Schumacher C, Krivoshei L, Hillinger P, Osswald S, Mueller C
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<70years, and BIS-1 in patients≥70years) 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 374days (IQR: 221 to 687days), 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.
PMID: 26355241 [PubMed - as supplied by publisher]