From the Guidelines
The presence of a single end-stage chronic illness is a significant predictor of end organ failure in the future, as it may cause significant symptoms or impairment of functional status and significantly reduce life expectancy. Predictors of end organ failure in the future include several key clinical and laboratory markers that can help identify patients at risk, such as elevated biomarkers, sustained hypertension, uncontrolled diabetes, and persistent proteinuria 1.
Key Predictors
- Elevated biomarkers such as BNP or NT-proBNP above 400 pg/mL for heart failure
- Creatinine levels exceeding 1.5 mg/dL for kidney failure
- Liver enzymes (ALT/AST) persistently above twice the normal range for liver failure
- Sustained hypertension (>140/90 mmHg)
- Uncontrolled diabetes (HbA1c >7.5%)
- Persistent proteinuria (>300 mg/day)
Imaging Findings
Imaging findings like reduced ejection fraction (<40%) on echocardiography, kidney size reduction on ultrasound, or liver fibrosis on elastography provide structural evidence of impending organ failure 1.
Lifestyle Factors
Lifestyle factors such as ongoing substance abuse, particularly alcohol consumption exceeding 3 drinks daily, significantly accelerate organ deterioration.
Pathophysiological Mechanisms
These predictors work through pathophysiological mechanisms including chronic inflammation, oxidative stress, fibrosis, and microvascular damage that progressively impair organ function.
Regular Monitoring
Regular monitoring of these parameters, especially in high-risk individuals, allows for early intervention with targeted therapies to potentially delay or prevent progression to end-stage organ failure.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Predictors of End Organ Failure
- The Bansal score and Kidney Failure Risk Equation (KFRE) can be used to predict mortality and end-stage renal disease in patients with chronic kidney disease (CKD) 2.
- A high Bansal score (≥7) is associated with a fourfold increase in the risk of all-cause mortality and a higher risk of dialysis initiation 2.
- Cardiovascular disease burden, depression, and malnutrition are also significant predictors of end organ failure in patients with CKD 2.
- The combination of beta-blockers and ACE inhibitors can be effective in reducing cardiovascular risk and disease outcomes, particularly in patients with hypertension and cardiovascular disease 3, 4.
- A risk-based approach to predicting and preventing heart failure can be useful in identifying high-risk individuals and guiding personalized decision making 5.
- Biomarkers, genomics-enhanced approaches, and other risk-enhancing features can be used to personalize risk estimation and reclassify risk in patients with heart failure 5.
Risk Factors for End Organ Failure
- Hypertension is a significant risk factor for cardiovascular disease and end organ failure 3, 4.
- Cardiovascular disease burden, including conditions such as arrhythmias, angina pectoris, and heart failure, can increase the risk of end organ failure 3.
- Depression and malnutrition are also significant risk factors for end organ failure, particularly in patients with CKD 2.
- Age and comorbid conditions, such as dementia, can also increase the risk of end organ failure 6.
Prevention and Management of End Organ Failure
- Early identification and management of risk factors, such as hypertension and cardiovascular disease, can help prevent end organ failure 3, 4.
- The use of cardioprotective therapies, such as ACE inhibitors, ARBs, and beta-blockers, can be effective in reducing cardiovascular risk and disease outcomes 3, 4.
- A comprehensive geriatric assessment (CGA) can be useful in identifying high-risk individuals and guiding personalized decision making 2.
- Palliative care and advance care planning can be important in improving outcomes and quality of life for patients with end organ failure 6.