National Taiwan University College of Medicine, NO.1, Jen-Ai Road Section 1, Taipei 10051, Taiwan.
National Taiwan University Hospital, NO.7, Chung-Shan South Road, Zhong-Zheng district, Taipei 10002, Taiwan.
Sci Rep. 2017 Feb 8;7:42030. doi: 10.1038/srep42030.
Although chronic kidney disease (CKD) is associated with functional decline, whether proteinuria alone is associated with functional statuses over the course of acute illnesses independent of CKD is unclear. During 2014, we prospectively enrolled non-dialysis patients aged ≥65 years, and all participants underwent spot dipstick urinalysis on admission, divided into 3 groups according to the results (none, trace to 1 + , and 2 + or higher); functional status was evaluated using the pre-morbid and in-hospital Barthel index (BI) scores. Of 136 community-dwelling elderly patients enrolled (age 80.7 ± 8.2 years, with 19% having CKD), 17%, 57%, and 26% had no, trace to 1 + , or 2 + or higher proteinuria. Overall pre-morbid, on-admission, and on-discharge BI scores were 50.4 ± 41.9, 38.6 ± 31.8, and 38.7 ± 35.3, respectively with significant negative correlations with proteinuric severity on admission. Finally, multivariate linear stepwise regression analysis with backward variable selection found that dipstick proteinuric severity was significantly associated with pre-morbid, on-admission, and on-dischrage BI scores (p = 0.048, <0.01, and <0.01, respectively), independent of diabetes and CKD. This relationship between dipstick proteinuric levels and functional status of hospitalized elderly suggests an under-recognized association. Prospective evaluation of long-term outcome is needed.
尽管慢性肾脏病 (CKD) 与功能下降有关,但蛋白尿是否独立于 CKD 与急性疾病过程中的功能状态有关尚不清楚。2014 年,我们前瞻性地招募了年龄≥65 岁的非透析患者,所有患者入院时均进行了即时尿干化学分析,根据结果分为 3 组(无、微量至 1+、2+或更高);使用入院前和住院期间的巴氏指数(BI)评分评估功能状态。在纳入的 136 名社区居住的老年患者中(年龄 80.7±8.2 岁,19%患有 CKD),17%、57%和 26%无、微量至 1+或 2+或更高蛋白尿。总体入院前、入院时和出院时的 BI 评分分别为 50.4±41.9、38.6±31.8 和 38.7±35.3,与入院时蛋白尿严重程度呈显著负相关。最后,采用向后变量选择的多元线性逐步回归分析发现,尿干化学蛋白尿严重程度与入院前、入院时和出院时的 BI 评分显著相关(p=0.048、<0.01 和<0.01),独立于糖尿病和 CKD。住院老年患者的尿干化学蛋白尿水平与功能状态之间的这种关系表明存在一种被低估的关联。需要对长期预后进行前瞻性评估。