Relative performance of three formulas to assess renal function at predicting in-hospital hemorrhagic complications in acute coronary syndrome population. What does the new CKD-EPI formula provide?

Abstract

Background: Assessment of renal function is critical for bleeding risk stratification in acute coronary syndrome (ACS) patients. Three formulas are mostly used to assess renal function: the Cockroft-Gault (C-G) formula, the MDRD-4 formula, and the new CKD-EPI equation. The relative performance of these formulas at predicting the risk of in-hospital bleeding is unknown in ACS patients. Methods and results: The study included 3270 ACS patients. The performance of each formula with respect to in-hospital TIMI major or TIMI minor bleeding were assessed using continuous data and by dividing patients into 4 subgroups according to the estimated glomerular filtration rate (eGFR): ≥90, 89 to 60, <60 to 30, and <30 ml/min/1.73 m2. The C-G formula estimated a significantly lower eGFR in women, the elderly, and those with low body weight than did the MDRD-4 and CKD-EPI formulas. The predictive accuracy was significantly higher for the C-G formula than for the MDRD-4 and CKD-EPI formulas, as evaluated by area under the curve (AUC); continuous eGFR AUCs: 0.73, 0.69, and 0.71, respectively; categorical eGFR AUCs: 0.77, 0.66, and 0.68, respectively). After multivariable adjustment, C-G predicted in-hospital bleeding better than the MDRD-4 (renal failure vs. normal renal function: odds ratio 7.98, 95% confidence interval (CI) 2.61–24.38 with the CG; odds ratio 3.76, 95% CI 1.63–8.69 with the MDRD-4; and odds ratio 5.78, 95% CI 2.19–15.25 with the CKD-EPI. Conclusions: Our findings suggest that the C-G formula is the most accurate of the 3 used eGFR formulas to improve risk stratification for in-hospital bleeding.