The prognostic value of estimated glomerular filtration rate change in elderly patients undergoing valvular replacement surgery.

Abstract

Background: While the estimated glomerular filtration rate (eGFR) is a common metric for assessing kidney function, its prognostic value in elderly patients undergoing valvular replacement surgery remains uncertain.

Methods: A total of 4531 elderly patients (aged ≥ 60 years) who underwent valvular replacement surgery at Guangdong Provincial People's Hospital in China were retrospectively included in the study, covering the period from January 2010 to April 2019. The patients were divided into four groups based on the difference between early postoperative and preoperative estimated glomerular filtration rates (eGFR): ΔeGFR ≤ 0, 0 < ΔeGFR ≤ 25, 25 < ΔeGFR < 50, and ΔeGFR ≥ 50. The association between postoperative eGFR changes and both in-hospital and one-year mortality was examined using univariate and multivariate analyses. Kaplan-Meier curves were used to illustrate cumulative hazard rates.

Result: Overall, 204 patients (4.5 %) died during their hospital stay, and 344 patients (7.59 %) patients died within one year. Our analysis revealed significant differences in clinical outcomes between patients with ΔeGFR ≤ 0 and those with ΔeGFR ≥ 50. Patients with ΔeGFR ≥ 50 had higher rates of postoperative dialysis (P < 0.001), acute heart failure (P = 0.037), and in-hospital mortality (P < 0.001). Cumulative survival curves showed a markedly higher one-year mortality rate among patients with ΔeGFR ≥ 50 compared to the other three groups (p < 0.0001). Multivariable analyses demonstrated a significant association between ΔeGFR ≥ 50 and both in-hospital mortality (OR = 2.939, P < 0.001) and one-year all-cause mortality (HR = 2.567, P < 0.001).

Conclusion: Our study identified ΔeGFR ≥ 50 as an independent risk factor for clinical events and in-hospital mortality.