Su Chien-Hao, Fan Pei-Chun, Cheng Ya-Lien, Wu Pao-Chu, Chen Chao-Yu, Lee Cheng-Chia, Chen Yung-Chang, Wu Victor Chien-Chia, Chu Pao-Hsien, Chang Chih-Hsiang
School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Pharmacy, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Front Cardiovasc Med. 2025 Apr 23;12:1447994. doi: 10.3389/fcvm.2025.1447994. eCollection 2025.
The definition of acute kidney dysfunction in patients with acute decompensated heart failure (ADHF) remains unclear. This study aimed to compare two sets of criteria for acute kidney injury (AKI), namely, the kidney disease: improving global outcomes (KDIGO) and worsening renal function (WRF) classification, in hospitalized patients with ADHF.
We utilized a multi-institutional database with 17,684 cases of hospitalizations for HF. AKI was defined using KDIGO, WRF-serum creatinine (Scr), and WRF-estimated glomerular filtration rate (eGFR) criteria. The study compared the performance of these criteria in predicting in-hospital mortality and employed logistic regression to assess associations with mortality, HF hospitalization, and major adverse kidney effects (MAKE). A sensitivity analysis was conducted to compare the modified KDIGO (mKDIGO) with the traditional AKI criteria.
The incidences of ADHF according to the KDIGO, WRF-Scr, and WRF-eGFR criteria were 28.6%, 29.9%, and 29.9%, respectively. KDIGO exhibited higher discriminatory power compared with WRF-Scr and WRF-eGFR for in-hospital mortality[area under the curve (AUC):73.6% vs. 71.6% vs. 71.2%]. On all definitions, ADHF was predicted to have an increase in mortality and MAKE, with mortality increasing stepwise with AKI severity. A sensitivity analysis revealed mKDIGO to be more accurate than WRF criteria for identifying in-hospital mortality and recognizing AKI early.
In hospitalized patients with ADHF, KDIGO is a more effective predictive tool for in-hospital mortality compared with WRF classification. Integrating a newer severity-staging classification into WRF criteria may enhance their predictive association with poor prognosis and enable early intervention.
急性失代偿性心力衰竭（ADHF）患者急性肾功能不全的定义仍不明确。本研究旨在比较急性肾损伤（AKI）的两套标准，即改善全球肾脏病预后组织（KDIGO）标准和肾功能恶化（WRF）分类，在住院ADHF患者中的应用情况。
我们使用了一个包含17684例心力衰竭住院病例的多机构数据库。采用KDIGO、WRF-血清肌酐（Scr）和WRF-估计肾小球滤过率（eGFR）标准来定义AKI。本研究比较了这些标准在预测住院死亡率方面的表现，并采用逻辑回归分析评估其与死亡率、心力衰竭住院率和主要不良肾脏事件（MAKE）的相关性。进行了敏感性分析，以比较改良的KDIGO（mKDIGO）与传统AKI标准。
根据KDIGO、WRF-Scr和WRF-eGFR标准，ADHF的发生率分别为28.6%、29.9%和29.9%。与WRF-Scr和WRF-eGFR相比，KDIGO在预测住院死亡率方面具有更高的辨别力[曲线下面积（AUC）：73.6%对71.6%对71.2%]。根据所有定义，ADHF患者的死亡率和MAKE预计会增加，死亡率随AKI严重程度逐步上升。敏感性分析显示，mKDIGO在识别住院死亡率和早期诊断AKI方面比WRF标准更准确。
在住院ADHF患者中，与WRF分类相比，KDIGO是预测住院死亡率更有效的工具。将更新的严重程度分期分类纳入WRF标准可能会增强其与不良预后的预测相关性，并实现早期干预。
