External validation of Cardio-Renal Scoring System VKPP (Validated Kidney Protection Program) in Patients with Acute Decompensated Heart Failure

External validation of Cardio-Renal Scoring System VKPP (Validated Kidney Protection Program) in Patients with Acute Decompensated Heart Failure

Irnizarifka, Hersunarti N, Rahardjo SB, Putri VK, Soerarso R, Siswanto BB.

 

Background : Although the management of Heart Failure (HF) has developed, prognosis still not significantly improved. It is due to comorbidities, especially worsening renal function (WRF), which also plays a major role in the pathophysiology of HF. In 2015, Putri et al have developed a scoring system (VKPP score) to predict WRF in patients with Acute Decompensated Heart Failure (ADHF), in which predictors are female, Hb < 12.5 mg/dl, admission creatinine > 2.5 mg/dl, history of hypertension, and age > 75 years . This scoring system yields discrimination value of 0.682 (95% CI; 0.630 to 0.734). External validation of the VKPP scoring system needed in order to implement them clinically.

Objective : To validate externally the VKPP Cardio-Renal scoring system in patients who are hospitalized with ADHF.

Methods : This is a retrospective cohort study with temporal external validation method that performed at the Department of Cardiology and Vascular Medicine, Universitas Indonesia/NCCHK, using secondary data from September 2015 until April 2016, which taken by consecutive sampling method. The data analysis is intended to develop the value of calibration and discrimination.

Results : The final samples are 418, with 20.3 % incidence of kidney function deterioration. Odds Ratio of all predictors is similar with the result in VKPP study, except female variable which is not a risk factor (OR 0.78; 95% CI; 0,43-1,45). As final, the calibration and discrimination values are ​​0.594 and 0.568 (95% CI; 0.502-0.634). In the validation study, the incidence of WRF in the low, moderate, and high risk group which are calculated using VKPP consecutively valued 18.6 % , 21.9 % and 29.6 %. However, only the low-risk group who were in the range of probability predictions of WRF, which is 11-26 % (moderate and high risk valued 27 to 49.5 % and 50-80 %).

Conclusion : VKPP scoring system externally valid to predict low risk group.

 

Keywords     :  worsening renal function, acute decompensated heart failure, scoring system, external validation