title: Impact of renal dysfunction on the Seattle Heart Failure Model.
abstract: BACKGROUND
  Renal dysfunction (RD) is a strong predictor of mortality in patients with heart failure (HF). However, its impact on the discrimination of the Seattle Heart Failure Model (SHFM) is poorly understood.
  
  
  METHODS
  Serum creatinine (SCr) and creatinine clearance (CrCl) were reviewed for patients from four of the six cohorts originally used to derive and validate the SHFM. Patients were followed for death. The independent prediction of adding SCr or CrCl to the SHFM was assessed using multivariable Cox proportional hazards and the incremental value for prediction by changes in the ROC curves for 1- and 2-year event prediction.
  
  
  RESULTS
  Among 7,146 patients (mean age 63 ± 11 years), 1,511 deaths occurred during a mean follow-up of 2.04 years. SCr and CrCl had a modest positive correlation with SHFM (r = 0.30, p = 0.002). In combination with SHFM, SCr (hazard ratio [HR] per mg/dl 1.25, 95% CI 1.13 to 1.38, p < 0.0001) and CrCl (HR per 10 ml/min 0.95, 95% CI 0.93 to 0.97, p < 0.0001) were both multivariable predictors of events. When stratified by absolute risk based on the SHFM, SCr or CrCl provided more additional information in lower risk patients and less or no additional information in higher risk patients. The addition of SCr and the SHFM*SCr, or CrCl and the SHFM*CrCl interaction to the SHFM was associated with almost no change in the 1- and 2-year area under ROC curves for the SHFM score.
  
  
  CONCLUSIONS
  Compared with the SHFM alone, RD is independently predictive of mortality only in lower risk patients. Overall discrimination is only minimally improved with addition of SCr or CrCl to the SHFM.
authors: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota. Electronic address: vakil012@umn.edu.
authors: Kairav P
authors: KP
authors: Vakil
authors: Division of Cardiology, University of Washington, Seattle, Washington.
authors: Todd
authors: T
authors: Dardas
authors: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors: Sunil
authors: S
authors: Dhar
authors: Division of Cardiology, University of Washington, Seattle, Washington.
authors: Alec
authors: A
authors: Moorman
authors: Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors: Inder
authors: I
authors: Anand
authors: Division of Cardiology, Italian Association of Hospital Cardiologists Research Center, Florence, Italy.
authors: Aldo
authors: A
authors: Maggioni
authors: Division of Cardiology, University of Washington, Seattle, Washington.
authors: David T
authors: DT
authors: Linker
authors: Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors: Dariush
authors: D
authors: Mozaffarian
authors: Division of Cardiology, University of Washington, Seattle, Washington.
authors: Wayne C
authors: WC
authors: Levy
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality*; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D003404:Creatinine
keywords: Seattle Heart Failure Model; chronic kidney disease; heart failure; risk prediction