Incremental value of renal function in risk prediction with the Seattle Heart Failure Model

Background Impaired renal function portends poor heart failure (HF) outcomes. The Seattle Heart Failure Score (SHFS), a multimarker risk assessment tool, however does not incorporate renal function. In this study, we assessed the incremental value of renal function over the SHFS in patients with advanced HF on contemporary optimal treatment. Methods Blood urea nitrogen (BUN), serum creatinine (sCr), BUN/sCr ratio, and estimated glomerular filtration rate were assessed in survival models with SHFS as the base model among 443 patients with HF (52 +/- 12 years, male 68.5%, white 52.4%, ejection fraction 0.18 +/- 0.08). Incremental value of renal function was assessed by changes in the likelihood ratio X 2 and the area under the receiver operating characteristic curves for 1-, 2-, and 3-year event prediction. Results During a median follow-up of 21 months, 108 (24.5%) of 443 patients had an event (death [n = 92], urgent transplantation In = 13], or ventricular assist device implantation In = 3]). All renal parameters individually were associated with outcome (BUN, P <.001; sCr, P <.001; BUN/sCr ratio, P =.006; and estimated glomerular filtration rate, P =.006); however, only BUN was an independent predictor of events in multivariable analyses. Addition of BUN improved the predictive ability of SHFS (Delta likelihood ratio X-2 5.03, P =.025); however, the increase in the area under the receiver operating characteristic curve was marginal (year 1, 0.786 to 0.791; year 2, 0.732 to 0.741; year 3, 0.745 to 0.754; all P >.2). Conclusion Among the various renal function parameters, BUN had the strongest association with outcomes in patients with advanced HE However, the incremental value of renal function over the SHFS for risk determination was marginal. (Am Heart J 2009;157:299-305.)