Hospital readmission remains a significant challenge for clinicians managing heart failure (HF) globally. Identifying biomarkers that accurately predict patient outcomes is essential for improving long-term care strategies. Recent research indicates that the hemoglobin-creatinine ratio heart failure patients show at admission is a powerful independent predictor of six-month all-cause readmission risk. This marker effectively combines two critical systems: hematological stability and renal function.

A retrospective cohort study evaluated 1,833 adults who survived an initial hospitalization for heart failure. The investigators calculated the HBCR by dividing admission hemoglobin levels by creatinine levels. Within six months post-discharge, 37.6% of these patients required readmission. Notably, the study revealed that lower HBCR levels significantly predicted a higher hazard of returning to the hospital. Consequently, after adjusting for demographics and comorbidities, each one standard deviation increase in HBCR corresponded to a 20% reduction in the readmission hazard.

Predicting Outcomes with the Hemoglobin-Creatinine Ratio Heart Failure Marker

Furthermore, the study highlighted that HBCR maintains its predictive power across various patient subgroups, including those with different age profiles. Heart failure typically affects multiple organs, particularly the kidneys, while anemia often complicates the clinical course. Therefore, a ratio that integrates these two factors provides a more comprehensive assessment of the patient's underlying physiological reserve. Moreover, the association remained robust even after accounting for established labs and comorbid conditions.

In addition to its prognostic accuracy, the HBCR is a remarkably cost-effective tool for risk stratification. Since both hemoglobin and creatinine are part of routine admission blood work, clinicians incur no additional diagnostic costs. This allows healthcare providers to implement more focused outpatient interventions for high-risk individuals immediately upon discharge. Specifically, prioritizing these patients for intensive follow-up may help reduce the overall burden on the healthcare system.

Frequently Asked Questions

What does a low hemoglobin-creatinine ratio indicate?

A lower HBCR indicates a higher risk of hospital readmission within six months. It reflects the presence of anemia or impaired renal function, both of which are independent risk factors for poor heart failure outcomes.

How is the HBCR calculated in clinical settings?

The HBCR is calculated by dividing the admission hemoglobin level (g/L) by the admission creatinine level (µmol/L). It serves as a simple, integrated biomarker that clinicians can use without ordering additional specialized tests.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider for any medical concerns or treatment. Refer to the latest local and national guidelines for clinical practice.

References

Li M et al. Association Between Hemoglobin-Creatinine Ratio and Six-Month All-Cause Readmission in Chinese Patients with Heart Failure: A Retrospective Cohort Study. Arch Med Res. 2026 Jun 09. doi: undefined. PMID: 42263346.

Lutai A et al. Serum Hemoglobin-to-Creatinine Ratio and Post-Discharge Readmission or Mortality in Older Patients With Heart Failure: A Retrospective Cohort Study. IMR Press. 2026 May 06. doi: 10.31083/j.rcm2705123.