title: Incremental value of renal function in risk prediction with the Seattle Heart Failure Model.
abstract: BACKGROUND
  Impaired renal function portends poor heart failure (HF) outcomes. The Seattle Heart Failure Score (SHFS), a multimarker risk assessment tool, however does not incorporate renal function. In this study, we assessed the incremental value of renal function over the SHFS in patients with advanced HF on contemporary optimal treatment.
  
  
  METHODS
  Blood urea nitrogen (BUN), serum creatinine (sCr), BUN/sCr ratio, and estimated glomerular filtration rate were assessed in survival models with SHFS as the base model among 443 patients with HF (52 +/- 12 years, male 68.5%, white 52.4%, ejection fraction 0.18 +/- 0.08). Incremental value of renal function was assessed by changes in the likelihood ratio chi(2) and the area under the receiver operating characteristic curves for 1-, 2-, and 3-year event prediction.
  
  
  RESULTS
  During a median follow-up of 21 months, 108 (24.5%) of 443 patients had an event (death [n = 92], urgent transplantation [n = 13], or ventricular assist device implantation [n = 3]). All renal parameters individually were associated with outcome (BUN, P < .001; sCr, P < .001; BUN/sCr ratio, P = .006; and estimated glomerular filtration rate, P = .006); however, only BUN was an independent predictor of events in multivariable analyses. Addition of BUN improved the predictive ability of SHFS (Deltalikelihood ratio chi(2) 5.03, P = .025); however, the increase in the area under the receiver operating characteristic curve was marginal (year 1, 0.786 to 0.791; year 2, 0.732 to 0.741; year 3, 0.745 to 0.754; all P > .2).
  
  
  CONCLUSIONS
  Among the various renal function parameters, BUN had the strongest association with outcomes in patients with advanced HF. However, the incremental value of renal function over the SHFS for risk determination was marginal.
authors.affiliation: Center for Heart Failure Therapy, Emory University, Atlanta, GA, USA.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Giamouzis
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.forename: Syed A
authors.initials: SA
authors.lastname: Agha
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Rashad
authors.forename: Sonjoy R
authors.initials: SR
authors.lastname: Laskar
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology*; D018570:Risk Assessment