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

Publication

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

Journal Paper/Review - Aug 11, 2015

Weidmann Zoraida Moreno, Haas Laurent, Jaeger Cedric, Wildi Karin, Puelacher Christian, Honegger Ursina, Wagener Max, Wittmer Severin, Schumacher Carmela, Krivoshei Lian, Hillinger Petra, Osswald Stefan, Stallone Fabio, Pershyna Kateryna, Breidthardt Tobias, Twerenbold Raphael, Züsli Christina, Nowak Albina, von Eckardstein Arnold, Erne Paul, Rentsch Katharina, de Oliveira Mucio T, Gualandro Danielle, Maeder Micha, Rubini Gimenez Maria, Mueller Christian

Citation

Weidmann Z, Haas L, Jaeger C, Wildi K, Puelacher C, Honegger U, Wagener M, Wittmer S, Schumacher C, Krivoshei L, Hillinger P, Osswald S, Stallone F, Pershyna K, Breidthardt T, Twerenbold R, Züsli C, Nowak A, von Eckardstein A, Erne P, Rentsch K, de Oliveira M, Gualandro D, Maeder M, Rubini Gimenez M, Mueller C. Prediction of mortality using quantification of renal function in acute heart failure. Int J Cardiol 2015; 201:650-7.

Type

Journal Paper/Review (English)

Journal

Int J Cardiol 2015; 201

Publication Date

Aug 11, 2015

Issn Electronic

1874-1754

Pages

650-7

Brief description/objective

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.