Urine albumin-to-creatinine ratio on admission predicts early rehospitalization in patients with acute decompensated heart failure
Urine albumin-to-creatinine ratio on admission predicts early rehospitalization in patients with acute decompensated heart failure
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DOI：
10.1007/s00380-022-02025-y
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发表时间：
2022-01-16
影响因子：
1.5
通讯作者：
Ishihara, Masaharu
中科院分区：
文献类型：
--
作者：
Matsumoto, Yuki;Orihara, Yoshiyuki;Ishihara, Masaharu
检测高危患者的早期再住院治疗在心力衰竭患者护理中至关重要。蛋白尿与心血管事件的相关性是众所周知的。然而，其对急性失代偿性心力衰竭（ADHF）再住院的预测作用仍然未知。在本研究中，入组了2017年至2019年4月期间因ADHF住院并接受尿分析的190例连续患者。对其中140例入院时采集尿标本测定尿白蛋白/肌酐比值（UACR）的患者进行进一步分析。评估UACR与出院后1年内因HF再住院之间的关系。140名参与者的平均年龄为77.6岁，55%为男性。只有18%（n = 25）的患者表现为正常白蛋白尿（UACR < 30 mg/g中心点肌酐），而59%（n = 83）和23%（n = 32）分别表现为微量白蛋白尿（UACR 30-300 mg/g中心点肌酐）和大量白蛋白尿（UACR > 300 mg/g中心点肌酐）。入院时的UACR水平与随后因HF再次住院的风险相关（p = 0.017）。受试者操作特征分析表明，UACR和B型利钠肽（BNP）水平预测ADHF再住院的最佳截止值分别为50 mg/g中心点肌酸酐和824 pg/ml。当使用两个临界值将患者分为四组时，UACR和BNP对再住院的个体预测影响相当。UACR和BNP水平均升高的患者再住院率高于BNP水平单独升高的患者（p < 0.05）。两个值的组合能够比单独BNP水平更准确地预测HF再住院。结论：UACR可能是预测ADHF患者再住院的一个新的有用的生物标志物，尤其是与BNP水平的联合应用，并应在前瞻性研究中进一步评估。
Detecting high-risk patients for early rehospitalization is crucial in heart failure patient care. An association of albuminuria with cardiovascular events is well known. However, its predictive impact on rehospitalization for acute decompensated heart failure (ADHF) remains unknown. In this study, 190 consecutive patients admitted due to ADHF between 2017 and April 2019 who underwent urinalysis were enrolled. Among them, 140 patients from whom urine albumin-to-creatinine ratio (UACR) was measured with spot urine samples on admission were further analyzed. The association between UACR and rehospitalization due to HF during 1 year after discharge was evaluated. The mean age of 140 participants was 77.6 years and 55% were men. Only 18% (n = 25) of patients presented with normoalbuminuria (UACR < 30 mg/g center dot creatinine), whereas 59% (n = 83) and 23% (n = 32) showed microalbuminuria (UACR 30-300 mg/g center dot creatinine) and macroalbuminuria (UACR > 300 mg/g center dot creatinine), respectively. The level of UACR on admission was correlated with the risk of subsequent rehospitalization due to HF (p = 0.017). The receiver operating characteristic analysis indicated that the best cut-off values for the UACR and B-type natriuretic peptide (BNP) levels to predict ADHF rehospitalization were 50 mg/g center dot creatinine and 824 pg/ml, respectively. When the patients were divided into four groups using both cut-off values, the individual predictive impacts of UACR and BNP on rehospitalization were comparable. Patients with both elevated UACR and BNP levels had a higher rate of HF rehospitalization than those with elevated BNP levels alone (p < 0.05). The combination of both values enabled more accurate prediction of HF rehospitalization than BNP levels alone. In conclusion, UACR could be a new useful biomarker to predict HF rehospitalization in patients with ADHF, especially in combination with the levels of BNP, and should be further evaluated in a prospective study.