The relationship between eGFR difference and in-hospital mortality in acute coronary syndrome patients stratified by chronic kidney disease.

BACKGROUND

The difference between estimated glomerular filtration rate (eGFRdiff), calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-cystatin C equation and the CKD-EPI creatinine equation, has significant clinical implications.

OBJECTIVE

This study aimed to investigate the association between eGFRdiff and in-hospital mortality in acute coronary syndrome (ACS) patients and assess whether eGFRdiff improves the predictive performance of the Global Registry of Acute Coronary Events (GRACE) score.

METHODS

We retrospectively analyzed data from 3731 ACS patients hospitalized at the China-Japan Friendship Hospital. eGFRdiff was defined as CKD-EPI creatinine-cystatin C eGFR minus CKD-EPI creatinine eGFR. Patients were categorized into negative (eGFRdiff < -10 mL/min/1.73m²), midrange (-10 to 10 mL/min/1.73m²), and positive (>10 mL/min/1.73m²) groups. The primary outcome was in-hospital death.

RESULTS

During hospitalization, 146 (3.91%) patients died. Multivariable logistic regression analysis demonstrated that lower eGFRdiff was independently associated with higher in-hospital mortality (negative vs. midrange group: odds ratio [OR] 1.84, 95% confidence interval [CI] 1.14-2.98; per 10 mL/min/1.73m² increment: OR 0.71, 95% CI 0.58-0.87). Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and in-hospital mortality in the overall cohort and chronic kidney disease (CKD) subgroup, but a linear association in non-CKD patients. Incorporating eGFRdiff into the GRACE score improved its predictive accuracy for in-hospital mortality, particularly in non-CKD patients.

CONCLUSION

eGFRdiff is inversely associated with in-hospital mortality risk in ACS patients. The integration of eGFRdiff into the GRACE score enhances risk stratification, suggesting that monitoring eGFRdiff may aid in clinical decision-making for ACS management.