Feasibility of multidomain cardiovascular-kidney-metabolic biomarker assessment for in-hospital mortality in older heart failure inpatients: an exploratory retrospective cohort study.
5 affiliations
- 1Department of Cardiology, Zhongnan Hospital, Institute of Myocardial Injury and Repair, Wuhan University, Wuhan University, Wuhan, 430071, PR China.
- 2Hubei Provincial Clinical Research Center for Cardiovascular Intervention, Wuhan, 430071, PR China.
- 3Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi, 710061, China.
- 4Department of Cardiology, Zhongnan Hospital, Institute of Myocardial Injury and Repair, Wuhan University, Wuhan University, Wuhan, 430071, PR China. [email protected].
- 5Hubei Provincial Clinical Research Center for Cardiovascular Intervention, Wuhan, 430071, PR China. [email protected].
Abstract
Background
Cardiovascular-kidney-metabolic (CKM) dysfunction integrates cardiac, renal, metabolic, and inflammatory risk and is particularly relevant for older patients hospitalized with heart failure. Whether standardized multidomain CKM-related biomarker assessment is feasible using real-world hospital data in older heart-failure inpatients and what limitations arise from such data remains poorly characterized.Methods
Retrospective cohort study using hospital records from Zhongnan Hospital (Jan 2022-Dec 2024). Patients with missing in-hospital outcome status were excluded. Primary outcome was in-hospital mortality. Associations between age, sex, ECG major abnormality, BNP, BUN, IL-6, and mortality were evaluated using Firth penalized logistic regression in complete-case patients. Nested ROC models described apparent discrimination (DeLong tests), bootstrap resampling estimated optimism-corrected discrimination, and an exploratory CKM biomarker burden analysis was performed.Results
Among 1,645 records, 1,131 patients had interpretable in-hospital outcomes (64 deaths, 1,067 survivors). A complete CKM biomarker panel (BNP, BUN, and IL-6) was available in only 186 patients (16.4%; 17 deaths, 169 survivors; median non-survivor age 82 years), who were older and had higher observed mortality than patients excluded for incomplete data. In this selected complete-case cohort, only older age (adjusted OR per year, 1.10; 95% CI, 1.04-1.16; P < 0.001) and BNP per doubling (OR, 1.40; 95% CI, 1.05-1.86; P = 0.021) were independently associated with mortality; sex, ECG major abnormality, BUN, and IL-6 were not. Apparent discrimination was numerically higher for the biomarker-enriched than the clinical-ECG model (AUC 0.841 vs. 0.762), but nested DeLong comparisons were not significant (P ≥ 0.060) and the optimism-corrected C-index was 0.79. Observed mortality rose across exploratory CKM-burden groups (8.3%, 12.0%, 20.0%), but these subgroups were very small. The incremental biomarker, ECG, discrimination, and CKM-burden findings remained exploratory and hypothesis-generating.Conclusions
In this selected complete-case cohort of older heart-failure inpatients, age and BNP were the most consistent markers of in-hospital mortality. A complete CKM biomarker panel was available in only a minority of patients, indicating that standardized multidomain CKM-related assessment was not systematically implemented in routine care. The feasibility, incremental prognostic value, and clinical utility of broader CKM-related multidomain biomarker assessment remain unproven and require standardized prospective validation; these findings should not be interpreted as a prognostic model ready for clinical use.
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BibTeX
@article{bashir2026feasibility,
title = {{Feasibility of multidomain cardiovascular-kidney-metabolic biomarker assessment for in-hospital mortality in older heart failure inpatients: an exploratory retrospective cohort study.}},
author = {Musa Bin Bashir and Chen Chen and Ho Yong Il and Rzgar Mustafa Ahmed and Navneet Navneet and Zhiquan Wang},
journal = {BMC geriatrics},
year = {2026},
month = jul,
doi = {10.1186/s12877-026-08047-9},
url = {https://europepmc.org/article/MED/42928107},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Feasibility of multidomain cardiovascular-kidney-metabolic biomarker assessment for in-hospital mortality in older heart failure inpatients: an exploratory retrospective cohort study.
AU - Musa Bin Bashir
AU - Chen Chen
AU - Ho Yong Il
AU - Rzgar Mustafa Ahmed
AU - Navneet Navneet
AU - Zhiquan Wang
PY - 2026
DA - 2026/07/28
JO - BMC geriatrics
DO - 10.1186/s12877-026-08047-9
UR - https://europepmc.org/article/MED/42928107
AB - Background Cardiovascular-kidney-metabolic (CKM) dysfunction integrates cardiac, renal, metabolic, and inflammatory risk and is particularly relevant for older patients hospitalized with heart failure. Whether standardized multidomain CKM-related biomarker assessment is feasible using real-world hospital data in older heart-failure inpatients and what limitations arise from such data remains poorly characterized.Methods Retrospective cohort study using hospital records from Zhongnan Hospital (Jan 2022-Dec 2024). Patients with missing in-hospital outcome status were excluded. Primary outcome was in-hospital mortality. Associations between age, sex, ECG major abnormality, BNP, BUN, IL-6, and mortality were evaluated using Firth penalized logistic regression in complete-case patients. Nested ROC models described apparent discrimination (DeLong tests), bootstrap resampling estimated optimism-corrected discrimination, and an exploratory CKM biomarker burden analysis was performed.Results Among 1,645 records, 1,131 patients had interpretable in-hospital outcomes (64 deaths, 1,067 survivors). A complete CKM biomarker panel (BNP, BUN, and IL-6) was available in only 186 patients (16.4%; 17 deaths, 169 survivors; median non-survivor age 82 years), who were older and had higher observed mortality than patients excluded for incomplete data. In this selected complete-case cohort, only older age (adjusted OR per year, 1.10; 95% CI, 1.04-1.16; P < 0.001) and BNP per doubling (OR, 1.40; 95% CI, 1.05-1.86; P = 0.021) were independently associated with mortality; sex, ECG major abnormality, BUN, and IL-6 were not. Apparent discrimination was numerically higher for the biomarker-enriched than the clinical-ECG model (AUC 0.841 vs. 0.762), but nested DeLong comparisons were not significant (P ≥ 0.060) and the optimism-corrected C-index was 0.79. Observed mortality rose across exploratory CKM-burden groups (8.3%, 12.0%, 20.0%), but these subgroups were very small. The incremental biomarker, ECG, discrimination, and CKM-burden findings remained exploratory and hypothesis-generating.Conclusions In this selected complete-case cohort of older heart-failure inpatients, age and BNP were the most consistent markers of in-hospital mortality. A complete CKM biomarker panel was available in only a minority of patients, indicating that standardized multidomain CKM-related assessment was not systematically implemented in routine care. The feasibility, incremental prognostic value, and clinical utility of broader CKM-related multidomain biomarker assessment remain unproven and require standardized prospective validation; these findings should not be interpreted as a prognostic model ready for clinical use.
SN - 1471-2318
ER -