Older adults admitted with heart failure often have problems with the heart, kidneys, metabolism and inflammation at the same time. This cluster is called cardiovascular-kidney-metabolic (CKM) dysfunction. A full CKM assessment sounds ideal on paper, but we wanted to know whether it is actually possible with the data hospitals already collect.

What we did

We used hospital records from Zhongnan Hospital (January 2022 to December 2024) to run an exploratory retrospective cohort study. From 1,645 records, 1,131 older heart failure inpatients had a known in-hospital outcome. We tested whether age, sex, major ECG abnormalities, BNP, BUN and IL-6 were linked to in-hospital death, using Firth penalized logistic regression, ROC analysis and bootstrap validation.

What we found

Only 16.4% of patients had a complete CKM biomarker panel. In routine care, a multidomain CKM assessment is still the exception rather than the rule.

Older age and higher BNP were the only factors independently linked to in-hospital mortality.

Sex, ECG abnormalities, BUN and IL-6 were not independently associated with mortality.

Why it matters

If we want CKM assessment to guide care for older heart failure patients, the biomarkers have to be measured consistently. Our results suggest hospitals need standardized CKM testing protocols, and future studies should validate these findings prospectively.

Read the full open-access article in BMC Geriatrics: https://doi.org/10.1186/s12877-026-08047-9