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Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study

  • Authors:
    • Nuril Farid Abshori
    • Syanindita Puspa Wardhani
    • Muhammad Nauval Dwi Afandi
    • Fitri Amalia
    • Aldivo Pradana
    • Anisatul Hamidah
    • Achmad Zainudin Arif
    • Iwal Reza Ahdi
    • Djanggan Sargowo
    • Muhammad Habiburrahman
  • View Affiliations / Copyright

    Affiliations: Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University Malang, Malang, East Java 65144, Indonesia, Faculty of Medicine, Universitas Brawijaya, Malang, East Java 65145, Indonesia, Faculty of Medicine, Universitas Muhammadiyah Surabaya Indonesia, Surabaya, East Java 60113, Indonesia, Department of Internal Medicine, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University Malang, Malang, East Java 65144, Indonesia, Department of Cardiology, Faculty of Medicine, Brawijaya University, Malang, East Java 65145, Indonesia, Faculty of Medicine, Imperial College London, London W12 0NN, UK
    Copyright: © Abshori et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 73
    |
    Published online on: June 25, 2026
       https://doi.org/10.3892/wasj.2026.488
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Abstract

Heart failure (HF) often coexists with renal dysfunction, which complicates the management and prolongs the length of stay (LOS) of patients in hospital. It is associated with an increased risk of in‑hospital complications, higher readmission rates and increased healthcare costs, placing a significant burden on both patients and healthcare systems. The present study evaluated whether renal biomarkers or echocardiographic indices can more effectively predict LOS in hospitalized patients with HF and compared the performance of predictive models derived from these features. In the present retrospective observational single‑center study, 112 adult patients admitted with HF between January, 2024 and May, 2025 were analyzed. LOS was evaluated both as a continuous variable and as a binary outcome (≤3 days vs. >3 days). Group comparisons employed the Mann‑Whitney U and Chi‑squared tests. Predictive models were constructed using logistic regression, linear regression and random forest algorithms. Three feature sets were assessed: i) Renal biomarkers [serum urea, creatinine and estimated glomerular filtration rate (eGFR)]; ii) echocardiographic left ventricular ejection fraction (LVEF); and iii) a combined set including renal biomarkers, LVEF, age, sex and diabetes status. The median LOS was 3 days (range, 1‑10 days). Patients with prolonged periods of hospitalization (>3 days) exhibited higher urea and creatinine levels, and a lower eGFR (all P≤0.003), whereas age, sex, diabetes and LVEF exhibited no significant association. Among the predictive models, the random forest model using the combined feature set achieved the highest discrimination (AUC, 0.74; 95% CI, 0.67‑0.85) and regression performance (R2=0.26). Models incorporating LVEF alone demonstrated limited predictive capacity, and the combined model did not substantially outperform renal biomarkers alone. Renal dysfunction independently predicts prolonged LOS in HF and outperforms LVEF. Integrating renal biomarkers into admission assessments can improve early risk stratification and guide clinical management by incorporating routinely available measures, such as serum creatinine and eGFR into standardized admission protocols, enabling the early identification of high‑risk patients.
View Figures

Figure 1

Flowchart of patient selection and
analytic workflow. Flow diagram illustrating the identification,
screening, and inclusion of patients hospitalized with heart
failure. Of 280 records initially assessed, 112 patients met the
inclusion criteria based on the availability of renal and
echocardiographic data and were retained for the final analysis.
eGFR, estimated glomerular filtration rate; LVEF, left ventricular
ejection fraction.

Figure 2

Model performance and feature
importance across clinical, renal, and echocardiographic
predictors. Comparative performance of predictive models using
different feature sets. (A) ROC curve for the logistic regression
model combining clinical, renal, and echocardiographic variables,
showing modest discrimination (AUC, 0.64). This suggests limited
ability of conventional linear models to reliably distinguish
patients at risk of prolonged hospitalization. (B) Feature
importance from the random forest model, identifying age and serum
urea as dominant predictors of prolonged hospitalization. This
highlights the greater prognostic relevance of renal biomarkers
compared with echocardiographic parameters. (C) Association between
predicted and observed LOS derived from the linear regression model
using renal biomarkers, demonstrating weak overall correlation,
indicates that renal function alone cannot fully explain
variability in LOS. (D) ROC curve for the gradient boosting model
trained on renal biomarkers, showing the strongest discrimination
(AUC, 0.76), suggests that advanced models capturing nonlinear
relationships may improve early identification of high-risk
patients. ROC, receiver operating characteristic; LOS, length of
stay.
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Spandidos Publications style
Abshori NF, Wardhani SP, Afandi MN, Amalia F, Pradana A, Hamidah A, Arif AZ, Ahdi IR, Sargowo D, Habiburrahman M, Habiburrahman M, et al: Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study. World Acad Sci J 8: 73, 2026.
APA
Abshori, N.F., Wardhani, S.P., Afandi, M.N., Amalia, F., Pradana, A., Hamidah, A. ... Habiburrahman, M. (2026). Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study. World Academy of Sciences Journal, 8, 73. https://doi.org/10.3892/wasj.2026.488
MLA
Abshori, N. F., Wardhani, S. P., Afandi, M. N., Amalia, F., Pradana, A., Hamidah, A., Arif, A. Z., Ahdi, I. R., Sargowo, D., Habiburrahman, M."Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study". World Academy of Sciences Journal 8.4 (2026): 73.
Chicago
Abshori, N. F., Wardhani, S. P., Afandi, M. N., Amalia, F., Pradana, A., Hamidah, A., Arif, A. Z., Ahdi, I. R., Sargowo, D., Habiburrahman, M."Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study". World Academy of Sciences Journal 8, no. 4 (2026): 73. https://doi.org/10.3892/wasj.2026.488
Copy and paste a formatted citation
x
Spandidos Publications style
Abshori NF, Wardhani SP, Afandi MN, Amalia F, Pradana A, Hamidah A, Arif AZ, Ahdi IR, Sargowo D, Habiburrahman M, Habiburrahman M, et al: Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study. World Acad Sci J 8: 73, 2026.
APA
Abshori, N.F., Wardhani, S.P., Afandi, M.N., Amalia, F., Pradana, A., Hamidah, A. ... Habiburrahman, M. (2026). Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study. World Academy of Sciences Journal, 8, 73. https://doi.org/10.3892/wasj.2026.488
MLA
Abshori, N. F., Wardhani, S. P., Afandi, M. N., Amalia, F., Pradana, A., Hamidah, A., Arif, A. Z., Ahdi, I. R., Sargowo, D., Habiburrahman, M."Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study". World Academy of Sciences Journal 8.4 (2026): 73.
Chicago
Abshori, N. F., Wardhani, S. P., Afandi, M. N., Amalia, F., Pradana, A., Hamidah, A., Arif, A. Z., Ahdi, I. R., Sargowo, D., Habiburrahman, M."Renal dysfunction and its impact on the duration of hospitalization in patients with heart failure based on insights from echocardiographic and laboratory parameters: A retrospective study". World Academy of Sciences Journal 8, no. 4 (2026): 73. https://doi.org/10.3892/wasj.2026.488
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