Forman et al developed a risk for predicting worsening of renal function (WRF) in a patient hospitalized for heart failure. Worsening of renal function is associated with increased complications in patients with heart failure. The authors are from multiple university medical centers in the United States.
Patient selection: adult >= 20 years of age hospitalized with heart failure
Exclusions included (page 62):
(1) elective hospitalization
(2) hospital stay < 2 days
(3) severe aortic stenosis
(4) anticipated cardiac transplantation
(5) transfer from within the hospital
(6) chronic dialysis
(7) use of left ventricular assist device
(8) high output heart failure
(9) treatment with chemotherapy
Worsening renal function was defined as an increase in serum creatinine > 0.3 mg/dL from that recorded on admission.
Parameters:
(1) previous history of congestive heart failure (CHF)
(2) diabetes mellitus
(3) systolic blood pressure
(4) serum creatinine
|
Parameter
|
Finding
|
Points
|
|
history of CHF
|
none
|
0
|
|
|
present
|
1
|
|
diabetes mellitus
|
absent
|
0
|
|
|
present
|
1
|
|
systolic blood pressure
|
<= 160 mm Hg
|
0
|
|
|
> 160 mm Hg
|
1
|
|
serum creatinine
|
< 1.5 mg/dL
|
0
|
|
|
1.5 - 2.49 mg/dL
|
1
|
|
|
>= 2.5 mg/dL
|
2
|
total risk score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum risk score: 0
• maximum risk score: 5
• The higher the risk score the greater the risk of renal function worsening.
|
Risk Score
|
Probability of Worsening Renal Function
|
|
0
|
10%
|
|
1
|
19%
|
|
2
|
20%
|
|
3
|
30%
|
|
4 or 5
|
53%
|
from Table 4, page 66
Problems in patients with heart failure and worsening renal function:
(1) longer hospital stay
(2) increased complications
(3) increased in-hospital mortality
