title: Incremental prognostic information from kidney function in patients with new onset coronary heart disease.
abstract: BACKGROUND
  Prognostic factors are usually evaluated by their statistical significance rather than by their clinical utility. Risk reclassification measures the extent to which a novel marker adds useful information to a prognostic model. The extent to which estimated glomerular filtration rate (eGFR) adds information about prognosis among patients with coronary heart disease is uncertain.
  
  
  METHODS
  We studied patients in an integrated health care delivery system with newly diagnosed coronary heart disease. We developed a model of the risk of death over 2 years of follow-up and then added eGFR to the model and measured changes in C-index, net reclassification improvement, and integrated discrimination improvement.
  
  
  RESULTS
  Almost half of the 31,533 study patients had reduced eGFR (<60 mL/min per 1.73 m(2)). Mortality was significantly higher among patients who had lower levels of eGFR, even after adjustment for baseline characteristics (P < .0001). The addition of eGFR to the prognostic model increased the C-index from 0.837 to 0.843, the net reclassification improvement by 3.2% (P < .0001), and integrated discrimination improvement by 1.3% (P = .007).
  
  
  CONCLUSIONS
  Estimated glomerular filtration rate is an informative prognostic factor among patients with incident coronary heart disease, independent of other clinical characteristics.
authors: Stanford University School of Medicine, Stanford, CA. Electronic address: hlatky@stanford.edu.
authors: Mark A
authors: MA
authors: Hlatky
authors: Stanford University School of Medicine, Stanford, CA.
authors: David
authors: D
authors: Shilane
authors: Stanford University School of Medicine, Stanford, CA.
authors: Tara I
authors: TI
authors: Chang
authors: Stanford University School of Medicine, Stanford, CA.
authors: Derek
authors: D
authors: Boothroyd
authors: Division of Research, Kaiser Permanente of Northern California, Oakland, CA; University of California, San Francisco, San Francisco, CA.
authors: Alan S
authors: AS
authors: Go
mesh_terms: D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D003404:Creatinine