title: The product of eGFR and hemoglobin may help predict mortality in systolic heart failure patients without severe anemia and renal failure.
abstract: OBJECTIVE
  Cardiorenal anemia syndrome is defined in patients with heart failure (HF). Although individual influences of renal impairment and anemia were shown previously, complex interaction between the kidney, bone marrow, and the heart renders decision making relatively inefficient in patients with milder forms of these diseases. We aimed to investigate whether product of estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) predicts outcomes in patients with HF.
  
  
  METHODS
  The study included 148 consecutive patients (89 males, 59 females; mean age 68±10 years) who were hospitalized with acutely decompensated systolic HF and discharged alive. Discharge Hb levels were measured. Renal function was estimated via the MDRD (Modification of Diet in Renal Disease) formula. The eGFRxHb product was derived, and cut-off was defined using the ROC (receiver operating characteristic) analysis. The influence of eGFRxHb product on mortality was analyzed after a follow-up period of up to 34 months (mean 8.2±5.5 months).
  
  
  RESULTS
  The mean Hb was 12.7±2 g/dl, the mean creatinine was 105±46 µmol/l, and the mean eGFR was 61±23 ml/min/1.73 m². Eighty-two patients (55.4%) had an eGFR of <60 ml/kg/m². During the follow-up, 27 patients died. Optimal cut-off level of eGFRxHb product to predict mortality was found to be ≤788 with a sensitivity of 82.6% and specificity of 51.3%. In multivariate Cox proportional analysis, only eGFRxHb product ≤788 (HR 4.488, 95% CI 1.500-13.433, p=0.007) and presence of atrial fibrillation (HR 2.644, 95% CI 1.113-6.280, p=0.028) were independent predictors of mortality in patients with HF.
  
  
  CONCLUSIONS
  We concluded that the product of eGFR and Hb might be useful in prediction of mortality among patients with systolic HF.
authors.affiliation: Department of Cardiology, Medicine Faculty of Cumhuriyet University, Sivas, Turkey. mehmet.birhan.yilmaz@tkd.org.tr
authors.forename: Mehmet Birhan
authors.initials: MB
authors.lastname: Yılmaz
authors.forename: Ali
authors.initials: A
authors.lastname: Zorlu
authors.forename: Gökhan
authors.initials: G
authors.lastname: Bektaşoğlu
authors.forename: Osman Can
authors.initials: OC
authors.lastname: Yontar
authors.forename: Izzet
authors.initials: I
authors.lastname: Tandoğan
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006454:Hemoglobins; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014421:Turkey
chemical_list: D006454:Hemoglobins