Page 139 - Biomarkers for risk stratification and guidance in heart failure

Chapter 6
Table 3. Univariable and adjusted multivariable hazard ratios for predictors of the combined endpoint HF free survival.
Univariate analysis
HR 95% CI Wald
Adjusted multivariate analysis
HF readmission / mortality
Previous episode of 2.91 heart failure
Myocardial infarction 1.90
Urea at hospital discharge (per 1.06 mmol/L)
eGFR at discharge (per mL/ 0.97 min/1.73m2)
LogNT-proBNP at hospital 3.18 discharge (per Log)
Increase versus decrease in 5.17 NT-proBNP
Decrease versus increase in 1.19 eGFR
Urea at discharge * Myoardial infarction
1.94 - 4.38 26.5
1.27 - 2.85 9.8 1.04 - 1.09 30.4
0.96 - 0.98 32.6 1.92 - 5.26 20.1 3.06 - 8.75 37.6 0.79 - 1.78 0.68
P HR
<0.001 2.0
0.002 2.51 <0.001 1.12
<0.001 0.99 <0.001 2.11 <0.001 4.04 0.410 1.27
95% CI
1.29 - 3.09
0.95 - 6.62 1.02 - 1.23
0.97 - 1.00 1.21 - 3.70 2.35 - 6.97 0.83 - 1.94
Wald P
9.7 0.002
3.5 0.062 5.1 0.024
2.7 0.103 6.8 0.009 25.3 <0.001 1.2 0.276 4.1 0.043
0.95 0.90 - 1.00
Hazard ratios calculated within the 1-year follow-up period.
DISCUSSION
In our study, early changes in NT-proBNP after hospital discharge due to acute HF had significant prognostic impact whereas changes in renal function did not. This finding might lead to the assumption that treatment of heart failure should be focused on improvement in cardiac function in such patients even if renal function slightly deteriorates.
Although not entirely uniform,3,14 most studies showed increased risk of worsening renal function (WRF) in heart failure patients. In a recently performed meta-analysis, presence of worsening renal function in both acute and chronic HF was associated with increased risk for mortality (OR 1.81, 95% CI 1.55-2.12, p<0.001).7 It has been postulated that any detectable decrease in renal function in patients hospitalized for HF has prognostic impact.15 Still, this is not confirmed for patients early after admission because of HF by our study, which is in line with a recent analysis showing no prognostic impact of mild WRF defined as an increase in creatinine of 0.2 up to 0.5 mg/dl, in a comparable outpatient setting.16 The prognostic impact of improvement of renal function (IRF) is less well known and mainly investigated in acute HF, where it has been associated with worse
138