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


RESULTS
We quantified renal function using five different formulas (Cockroft-Gault, MDRD-4, MDRD-6, CKD-EPI in patients<70 years, and BIS-1 in patients≥70 years) 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 374 days (IQR: 221 to 687 days), 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.
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Zoraida Moreno
ZM
Weidmann
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Internal Medicine, University Hospital, Basel, Switzerland.
Tobias
T
Breidthardt
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Raphael
R
Twerenbold
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Christina
C
Züsli
Department of Internal Medicine, University Hospital, Zurich, Switzerland.
Albina
A
Nowak
Department of Laboratory Medicine, University Hospital, Zurich, Switzerland.
Arnold
A
von Eckardstein
Department of Cardiology, Spital St. Anna, Luzern, Switzerland.
Paul
P
Erne
Department of Laboratory Medicine, University Hospital, Basel, Switzerland.
Katharina
K
Rentsch
Cardiology and Emergency Department, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
Mucio T
MT
de Oliveira
Cardiology and Emergency Department, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
Danielle
D
Gualandro
Department of Cardiology, Kantonsspital St. Gallen, Switzerland.
Micha T
MT
Maeder
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Maria
M
Rubini Gimenez
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Kateryna
K
Pershyna
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Fabio
F
Stallone
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Laurent
L
Haas
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Cedric
C
Jaeger
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Karin
K
Wildi
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Christian
C
Puelacher
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Ursina
U
Honegger
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Max
M
Wagener
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Severin
S
Wittmer
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Carmela
C
Schumacher
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Lian
L
Krivoshei
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Petra
P
Hillinger
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland.
Stefan
S
Osswald
Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland; Department of Cardiology, University Hospital, Basel, Switzerland. Electronic address: Christian.Mueller@usb.ch.
Christian
C
Mueller
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000503:physiopathology*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
Acute heart failure; Mortality; Renal function