Dipstick proteinuria as a surrogate marker of long-term mortality after acute myocardial infarction
Dipstick proteinuria as a surrogate marker of long-term mortality after acute myocardial infarction
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DOI：
10.1016/j.jjcc.2013.05.002
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发表时间：
2013-11-01
影响因子：
2.5
通讯作者：
Hasebe, Naoyuki
中科院分区：
文献类型：
--
作者：
Ota, Hisanobu;Takeuchi, Toshiharu;Hasebe, Naoyuki
背景：蛋白尿和估计肾小球滤过率 (eGFR) 降低与急性心肌梗死 (AMI) 死亡风险增加相关。然而，尚不清楚 AMI 后蛋白尿和 eGFR 对全因死亡率的预后价值是否存在差异。方法：连续纳入 101 名因 AMI 入院并接受血管成形术的患者。入院时对试纸蛋白尿和 eGFR 进行评估：（i）根据是否存在蛋白尿（蛋白尿，n = 25）或不存在（蛋白尿，n = 76）将患者分为 2 组，（ii）根据 eGFR 较低情况将患者分为 2 组（GFR 60 mL/min/1.73 m(2)，n = 70）。评估各组的临床特征和通过Kaplan-Meier法估计的3年全因死亡率。此外，应用多变量 Cox 比例风险模型来评估哪个因素与全因死亡率相关。结果：平均随访期为 914 天。蛋白尿组和 eGFR 较低组的脑钠肽 (BNP) 水平分别较高（蛋白尿，301 324 pg/mL；阴性，146 159 pg/mL；p = 0.02；较低的 eGFR，294 305 pg/mL；较高的 eGFR，142 161 pg/mL；p = 0.02）。蛋白尿组的三年全因死亡率高于正常组 (p < 0.001)，而 eGFR 较低组的三年全因死亡率高于 eGFR 高组 (p = 0.006)。在 Cox 比例风险模型中，蛋白尿的存在 [风险比（95% 置信区间），4.51 (1.07-18.96)； p = 0.04] 被选为全因死亡率的预测因子之一。结论：AMI 随访早期阶段的试纸蛋白尿和较低的 eGFR 与亚急性期血浆 BNP 水平升高和长期不良结局相关。试纸蛋白尿可能是长期全因死亡率的预后标志。 (C) 2013 年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Proteinuria and reduced estimated glomerular filtration rate (eGFR) are associated with an increased risk of mortality from acute myocardial infarction (AMI). However, it is unknown whether there is a difference in prognostic value for all-cause mortality between proteinuria and eGFR during post-AMI.Methods: A consecutive series of 101 patients admitted with AMI who received angioplasty were enrolled. Dipstick proteinuria and eGFR were assessed on admission: (i) the patients were divided into 2 groups according to the presence of proteinuria (proteinuria, n = 25), or not (negative, n = 76), (ii) the patients were divided into 2 groups according to lower eGFR (GFR 60 mL/min/1.73 m(2), n = 70). Clinical characteristics and 3-year all-cause mortality estimated by Kaplan-Meier method were evaluated in each group. Additionally, a multivariate Cox proportional hazards model was applied to evaluate which factor was associated with all-cause mortality.Results: Mean follow-up period was 914 days. Higher brain natriuretic peptide (BNP) levels were shown in the proteinuria and lower eGFR groups, respectively (proteinuria, 301 324 pg/mL; negative, 146 159 pg/mL; p = 0.02; lower eGFR, 294 305 pg/mL; higher eGFR, 142 161 pg/mL; p = 0.02). Threeyear all-cause mortality was higher in the proteinuria group than in the normal group (p < 0.001) and in the lower eGFR group than in the higher group (p = 0.006). In a Cox proportional hazards model, the presence of proteinuria [hazard ratio (95% confidence interval), 4.51 (1.07-18.96); p = 0.04] was selected as one of the predictors for all-cause mortality.Conclusions: Dipstick proteinuria and lower eGFR in the early phase of AMI follow-up were related to increased plasma BNP level during the sub-acute phase and long-term adverse outcome. Dipstick proteinuria may be a prognostic marker for long-term all-cause mortality. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.