Admission eGFR (OR 0.88; 95% CI 0.83-0.94; p<0.001) and ΔeGFR independently predicted 12-month mortality in acute heart failure, though only baseline eGFR showed significant discriminative ability.
Observational (n=121)
Do admission eGFR and in-hospital variation (ΔeGFR) predict mortality in patients admitted with acute heart failure?
Admission eGFR is a stronger discriminator of long-term mortality than short-term in-hospital renal variation in patients with acute heart failure.
Effect estimate: OR 0.88 (95% CI 0.83-0.94)
p-value: p=<0.001
Abstract Introduction Renal dysfunction strongly influences prognosis in acute heart failure (AHF). While admission eGFR is a recognized predictor of mortality, the impact of in-hospital renal variation (ΔeGFR) remains uncertain. Understanding both static and dynamic renal parameters may refine risk stratification in AHF. Purpose This study aimed to assess the relationship between eGFR, ΔeGFR, and mortality in patients admitted with AHF. Methods We conducted a retrospective observational study including 121 consecutive patients admitted to a medical ward with AHF. Clinical, laboratory, and echocardiographic data were collected from electronic medical records. Renal function was assessed using estimated glomerular filtration rate (eGFR, CKD-EPI equation) at admission and its in-hospital variation (ΔeGFR). The primary outcome was 12-month all-cause mortality; secondary endpoints included 6-month mortality and length of hospital stay. Statistical analyses included logistic regression, receiver operating characteristic (ROC) curve analysis, Mann–Whitney U test, and Spearman correlation, as appropriate. Results Among 121 patients (median age 81 75–87 years, 56.2% male), hypertension (78.5%), dyslipidemia (63.6%), and atrial fibrillation (62.8%) were the most prevalent comorbidities, while 33.9% had chronic kidney disease. Mean admission eGFR was 77.1 ± 13.4 mL/min/1.73m², and median ΔeGFR during hospitalization was −2.4 −5.9 - +2.5 mL/min/1.73m². In multivariable logistic regression, both admission eGFR (OR 0.88, 95% CI 0.83–0.94, p 0.001) and ΔeGFR (OR 0.88, 95% CI 0.81–0.97, p =0.008) were independent predictors of 12-month mortality, with a model accuracy of 77.7% (Nagelkerke R²=0.31). ROC analysis demonstrated a significant inverse discriminative relationship between admission eGFR and mortality (AUC=0.233, 95% CI 0.142–0.325, p 0.001), whereas ΔeGFR showed no discriminative performance (AUC=0.513, 95% CI 0.398–0.629, p =0.820). At 6 months, non-survivors had lower baseline eGFR compared to survivors (67.5 ± 6.9 vs 78.6 ± 13.6 mL/min/1.73m², p 0.001), while ΔeGFR did not differ (p =0.196). No correlation was found between admission eGFR or ΔeGFR and length of hospital stay (ρ=−0.09, p=0.31; ρ=−0.01, p=0.90, respectively). Conclusion Both admission eGFR and ΔeGFR were independently associated with 12-month mortality, but only baseline eGFR demonstrated significant discriminative ability. These findings reinforce that renal function at presentation - rather than short-term variation - plays the predominant role in determining long-term prognosis in acute heart failure, emphasizing its importance in early risk stratification.
Ventura et al. (Fri,) conducted a observational in Acute heart failure (n=121). Admission eGFR and in-hospital renal variation (ΔeGFR) was evaluated on 12-month all-cause mortality (OR 0.88, 95% CI 0.83-0.94, p=<0.001). Admission eGFR (OR 0.88; 95% CI 0.83-0.94; p<0.001) and ΔeGFR independently predicted 12-month mortality in acute heart failure, though only baseline eGFR showed significant discriminative ability.