Schiele François, Meneveau Nicolas, Chopard Romain, Descotes-Genon Vincent, Oettinger Joanna, Seronde Marie France, Briand Florent, Bernard Yvette, Ecarnot Fiona, Bassand Jean-Pierre
Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France.
Am Heart J. 2009 Feb;157(2):327-33. doi: 10.1016/j.ahj.2008.09.018. Epub 2008 Dec 3.
An increase in albuminuria occurs in the early days after acute myocardial infarction. The aim of this study was to assess the relation between albuminuria and 30-day mortality, as well as its incremental predictive value, on top of established prognostic parameters.
Demographic, clinical, and biological characteristics at admission, as well as in-hospital treatments and 1-month survival, were recorded in 1,211 consecutive patients admitted for acute myocardial infarction. Albuminuria was assessed from an 8-hour overnight urine collection within the first 2 days using immunonephelemetry. The population was categorized into 3 groups according to albuminuria levels (<20, 20-200, and >200 microg/min). Among survivors on day 2, 52% (625/1,211) of patients had an albuminuria level <20 microg/min, 39% (477) between 20 and 200 microg/min, and 9% (109) >200 microg/min. High levels of albuminuria were associated with older age, peripheral vessel disease, systolic blood pressure, glucose, creatinine, troponin, B-type natriuretic peptide, and high-sensitivity C reactive protein levels, as well as use of angiography, angiotensin-converting enzyme inhibitors, and beta blockers. At 1 month, there was a significantly higher mortality rate in groups with higher albuminuria. After adjustment for baseline characteristics, patients with albuminuria level of >20 microg/min had a 2.7-fold higher 30-day mortality, and those with >200 microg/min had an almost 4-fold higher 30-day mortality compared to those with albuminuria level of <20 microg/min. The addition of albuminuria information improved the discrimination capacity of the model and the global risk prediction.
Albuminuria level, taken as a quantitative or categorical variable, is an independent and powerful predictor of mortality after acute myocardial infarction.
急性心肌梗死后早期会出现蛋白尿增加。本研究的目的是评估蛋白尿与30天死亡率之间的关系，以及在既定预后参数基础上其增加的预测价值。
记录了1211例因急性心肌梗死入院的连续患者入院时的人口统计学、临床和生物学特征，以及住院治疗情况和1个月生存率。在入院后的前两天内，通过免疫比浊法对8小时夜间尿液收集样本进行蛋白尿评估。根据蛋白尿水平（<20、20 - 200和>200微克/分钟）将人群分为3组。在第2天存活的患者中，52%（625/1211）的患者蛋白尿水平<20微克/分钟，39%（477例）在20至200微克/分钟之间，而9%（109例）>200微克/分钟。高蛋白尿水平与老年、外周血管疾病、收缩压、血糖、肌酐、肌钙蛋白、B型利钠肽和高敏C反应蛋白水平，以及血管造影、血管紧张素转换酶抑制剂和β受体阻滞剂的使用有关。在1个月时，高蛋白尿组的死亡率显著更高。在对基线特征进行调整后，与蛋白尿水平<20微克/分钟的患者相比，蛋白尿水平>20微克/分钟的患者30天死亡率高2.7倍，而>200微克/分钟的患者30天死亡率几乎高4倍。加入蛋白尿信息提高了模型的鉴别能力和整体风险预测能力。
蛋白尿水平作为定量或分类变量，是急性心肌梗死后死亡率的独立且有力的预测指标。
