Vol. 7, Issue 2, Part B (2025)

Background: Acute decompensated heart failure (ADHF) outcomes are significantly impacted by the cardio-renal interaction. This work aimed to assess prognostic value of admission estimated glomerular filtration rate (eGFR) and serum creatinine for forecasting the outcomes of patients with ADHF and reduced ejection fraction (HFrEF) while they are hospitalized.
Methods: An observational prospective study was executed at Tanta University Hospitals from April 1, 2024, to April 1, 2025. We enrolled 100 consecutive adult patients hospitalized with ADHF and LVEF ≤40%. Exclusion criteria included patients undergoing dialysis due to end-stage renal disease, HFmrEF, or HFpEF. Admission eGFR and serum creatinine (utilizing the 2021 CKD-EPI equation) were measured. The primary outcomes were mortality rates when patients were hospitalized, requirement of renal replacement therapy (RRT), diuretic resistance (need for high-dose or combined diuretics), and length of stay.
Results: The mortality rates when patients were hospitalized rate was 29%. Non-survivors had significantly higher admission serum creatinine (3.5±1.4 mg/dL vs. 1.8±0.9 mg/dL, p<0.001) and lower eGFR (24.0±13.09 mL/min/1.73m² vs. 47.61±24.52 mL/min/1.73m², p<0.001) compared to survivors. A mortality rate of 88.9% and the necessity for RRT and high-dose diuretics were both correlated to eGFR <15 mL/min/1.73m². Alternatively, no patient who had eGFR of 60 mL/min/1.73 m² required RRT or died. The researchers demonstrated a strong negative association (rs = -0.671, p<0.001) between eGFR and duration of hospital stay.
Conclusion: Admission serum creatinine and eGFR are powerful, readily available predictors of in-hospital mortality, diuretic resistance, need for RRT, and prolonged hospitalization in patients with ADHF and HFrEF. These parameters should be integral to early risk stratification to guide intensive management.