The value of spot urinary creatinine as a marker of muscle wasting in patients with new-onset or worsening heart failure.
The value of spot urinary creatinine as a marker of muscle wasting in patients with new-onset or worsening heart failure.
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现场尿肌酐作为新发或恶化心力衰竭患者肌肉萎缩标志物的价值。
DOI：
10.1002/jcsm.12690
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Ter Maaten JM
中科院分区：
文献类型：
--
作者：
Pandhi P;Streng KW;Anker SD;Cleland JG;Damman K;Dickstein K;Pellicori P;Lang CC;Ng L;Samani NJ;Zannad F;Metra M;Rossignol P;Filippatos G;van Veldhuisen DJ;Voors AA;Ter Maaten JM
肌肉萎缩和无意体重减轻（恶病质）与心力衰竭（HF）的不良结果相关，但及时识别这些不良现象是困难的。点尿肌酐可能是一个容易获得的标志物，以评估肌肉损失和恶病质。本研究探讨了尿肌酐与新发或恶化HF （WHF）患者体成分变化和预后的关系。在BIOSTAT‐CHF研究中，来自国际队列（指数队列）的2315例新发或WHF患者和来自苏格兰的1431例类似患者的验证队列的基线点尿肌酐测量值可用。在指标队列中，中位点尿肌酐浓度为5.2 [2.7-9.6]mmol/L。中位年龄为69±12岁，73%为男性。较低的点尿肌酐与年龄较大、身高和体重较低、肾功能较差、心衰较严重以及从基线到9个月体重下降5%的较高风险相关（比值比= 1.23,95% CI = 1.09-1.39 / log下降；P = 0.001）。在分层聚类分析中，点尿肌酐与Evans恶病质标准相关（OR = 1.26 / log下降，95% CI = 1.04-1.49; P = 0.016），并与心力衰竭严重程度标记物聚类。较低的尿肌酐与较差的运动能力和生活质量相关（均P < 0.001），并预测较高的全因死亡率[每对数下降的危险比(HR) = 1.27, 95% CI = 1.17-1.38；P < 0.001]和合并终点HF住院或全因死亡率（HR = 1.23, 95% CI = 1.15-1.31，每对数下降；P < 0.001）。加入BIOSTAT风险模型后，其意义就丧失了。对验证队列的分析得出了类似的结果。在新发/WHF患者中，较低的点尿肌酐与较小的体型、肾功能障碍和更严重的HF有关。此外，较低的点尿肌酐与体重减轻的风险增加和较差的运动能力/生活质量有关。因此，尿肌酐可能是一种新的、容易获得的评估心力衰竭患者肌肉萎缩（风险）的标志物。
Muscle wasting and unintentional weight loss (cachexia) have been associated with worse outcomes in heart failure (HF), but timely identification of these adverse phenomena is difficult. Spot urinary creatinine may be an easily accessible marker to assess muscle loss and cachexia. This study investigated the association of urinary creatinine with body composition changes and outcomes in patients with new‐onset or worsening HF (WHF). In BIOSTAT‐CHF, baseline spot urinary creatinine measurements were available in 2315 patients with new‐onset or WHF in an international cohort (index cohort) and a validation cohort of 1431 similar patients from Scotland. Median spot urinary creatinine concentrations were 5.2 [2.7–9.6] mmol/L in the index cohort. Median age was 69 ± 12 years and 73% were men. Lower spot urinary creatinine was associated with older age, lower height and weight, worse renal function, more severe HF, and a higher risk of >5% weight loss from baseline to 9 months (odds ratio = 1.23, 95% CI = 1.09–1.39 per log decrease; P = 0.001). Spot urinary creatinine was associated with Evans criteria of cachexia (OR = 1.26 per log decrease, 95% CI = 1.04–1.49; P = 0.016) and clustered with markers of heart failure severity in hierarchical cluster analyses. Lower urinary creatinine was associated with poorer exercise capacity and quality of life (both P < 0.001) and predicted a higher rate for all‐cause mortality [hazard ratio (HR) = 1.27, 95% CI = 1.17–1.38 per log decrease; P < 0.001] and the combined endpoints HF hospitalization or all‐cause mortality (HR = 1.23, 95% CI = 1.15–1.31 per log decrease; P < 0.001). Significance was lost after addition of the BIOSTAT risk model. Analyses of the validation cohort yielded similar findings. Lower spot urinary creatinine is associated with smaller body dimensions, renal dysfunction, and more severe HF in patients with new‐onset/WHF. Additionally, lower spot urinary creatinine is associated with an increased risk of weight loss and a poorer exercise capacity/quality of life. Urinary creatinine could therefore be a novel, easily obtainable marker to assess (risk of) muscle wasting in HF patients.
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影响因子：
39.3
作者：
Fuelster, Susann;Tacke, Matthias;von Haehling, Stephan
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