What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=14591). Intervention: Estimated glomerular filtration rate (eGFR) 30-44 mL/min/1.73 m2 vs. eGFR ≥ 90 mL/min/1.73 m2. Primary outcome: All-cause in-hospital mortality (OR 1.36, 95% CI 1.07-1.75, p=0.014).

What question did this study set out to answer?

This study aims to evaluate the independent association between estimated glomerular filtration rate (eGFR) and in-hospital mortality in heart failure patients.

June 12, 2026Open Access

Association of estimated glomerular filtration rate and in-hospital mortality in patients hospitalized for heart failure: a retrospective cohort study

Key Result

An estimated glomerular filtration rate below 60 mL/min/1.73 m2 was independently associated with a 37% higher risk of in-hospital mortality (OR 1.37) among patients hospitalized for heart failure.

Key Points

This study aims to evaluate the independent association between estimated glomerular filtration rate (eGFR) and in-hospital mortality in heart failure patients.
Retrospective cohort study of 14,591 patients hospitalized for heart failure from 2009 to 2024.
eGFR categorized into five groups and assessed for all-cause mortality using multivariable logistic regression.
Restricted cubic spline modeling analyzed the nonlinear relationship between eGFR and in-hospital mortality.
In-hospital mortality rates increased across eGFR categories, ranging from 5.77% to 11.72%.
After adjustment, eGFR categories 45-59 and 30-44 mL/min/1.73 m² had higher mortality risks with OR 1.27 and OR 1.36 respectively (P=0.036 and P=0.014).
Patients with eGFR <60 mL/min/1.73 m² had a 37% higher mortality risk (OR 1.37, P<0.001), significantly impacted by NYHA functional class.

Study Design

Type

Cohort (n=14,591)

Multicenter

Structured PICO

Does reduced eGFR increase the risk of all-cause in-hospital mortality in patients hospitalized for heart failure?

Population

14,591 adults hospitalized for heart failure at a single tertiary center in China, evaluated for the association between admission estimated glomerular filtration rate and in-hospital mortality.

Exposure

Reduced estimated glomerular filtration rate (eGFR) categorized into strata: 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2

Comparator

Normal or high estimated glomerular filtration rate (eGFR ≥ 90 mL/min/1.73 m2)

Outcome

All-cause in-hospital mortalityhard clinical

Reduced eGFR (<60 mL/min/1.73 m2) is a strong, independent prognostic factor for increased in-hospital mortality in patients hospitalized for heart failure, with risk rising steeply below this threshold.

Main Result

Odds Ratio: 1.36 (95% CI 1.07–1.75)

Absolute Event Rate: 11.72% vs 5.77%

p-value: p=0.014

Limitations

Retrospective, observational design cannot establish causality.
Lack of urinary protein or other kidney-specific biomarkers for more accurate eGFR assessment.
Potential influence of unmeasured or unrecorded confounding variables.
Single-center study limits the generalizability of the findings to broader populations.

Abstract

Background Assessment of mortality risk in hospitalized patients with heart failure (HF) constitutes a core tenet of clinical management. Renal function, as quantified by estimated glomerular filtration rate (eGFR), is a key prognostic factor for adverse outcomes; however, its independent association with in-hospital mortality has not been fully elucidated. We quantify the independent prognostic impact of eGFR on the risk of in-hospital mortality and to characterize its underlying nonlinear relationship. Methods We retrospectively enrolled 14,591 patients hospitalized for HF at a tertiary care center (2009–2024). eGFR was calculated via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and categorized into five categories: ≥90, 60–89, 45–59, 30–44, and 30 mL/min/1.73 m 2 . The primary end point was all-cause in-hospital mortality. Multivariable logistic regression with stepwise covariate adjustment, subgroup analyses, and restricted cubic spline (RCS) modeling were performed to evaluate the association between eGFR and mortality. Results In-hospital mortality rates increased progressively across eGFR strata: 5.77%, 6.37%, 8.19%, 11.72%, and 10.93%, respectively. After full covariate adjustment (Model 3), compared with eGFR ≥ 90 mL/min/1.73 m 2 , eGFR 45–59 and 30–44 mL/min/1.73 m 2 were independently associated with a higher in-hospital mortality risk (OR 1.27, 95% CI 1.02–1.58, P = 0.036; OR 1.36, 95% CI 1.07–1.75, P = 0.014). Subgroup analysis showed that patients with eGFR 60 mL/min/1.73 m 2 had a 37% higher risk of in-hospital mortality (OR1.37, 95% CI 1.19–1.58, P 0.001). A significant interaction was observed between eGFR and New York Heart Association (NYHA) functional class ( P for interaction 0.001), with the risk of in-hospital mortality being significantly amplified in patients with NYHA class Ⅲ (OR 1.75) and class Ⅳ (OR 2.13). RCS analysis revealed a nonlinear association between eGFR and in-hospital mortality risk ( P for nonlinearity 0.001), with a critical inflection point at approximately 60 mL/min/1.73 m 2 ; below this threshold, the risk of in-hospital mortality increased sharply. Conclusions Reduced eGFR is a strong, independent prognostic factor for in-hospital mortality in patients hospitalized for HF, particularly in those with New NYHA class III/IV. The risk of in-hospital mortality rises steeply when eGFR is below 60 mL/min/1.73 m 2 . These findings support routine eGFR-guided risk stratification and early intensive monitoring in patients with advanced HF.

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