Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan.
Department of Cardiovascular Medicine, Hokkaido University, Japan.
Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):429-436. doi: 10.1177/2048872620901986. Epub 2020 Jan 28.
The prognostic significance of urinary -acetyl-β-D-glucosamidase in acute heart failure has not been fully elucidated. Accordingly, this study investigated whether urinary -acetyl-β-D-glucosamidase could be associated with subsequent adverse events in acute heart failure patients.
We studied 708 consecutive acute heart failure patients who had accessible -acetyl-β-D-glucosamidase data on admission from the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure registry. We assessed the relationship between the admission -acetyl-β-D-glucosamidase level and the combined endpoint of all-cause death and worsening heart failure. Worsening heart failure was defined as worsening symptoms and signs of heart failure requiring intensification of intravenous therapy such as diuretics, vasodilators and inotropes or initiation of mechanical support after stabilisation with initial treatment during hospitalisation, or readmission due to heart failure after discharge.
During a median follow-up period of 763 (interquartile range 431-1028) days, higher urinary -acetyl-β-D-glucosamidase was significantly related to increased events of all-cause death and worsening heart failure. In addition, patients with higher urinary -acetyl-β-D-glucosamidase and lower estimated glomerular filtration rate on admission had the worst clinical outcomes. In multivariable Cox regression, urinary -acetyl-β-D-glucosamidase on admission was independently associated with adverse events (hazard ratio 1.19, 95% confidence interval 1.04-1.35) even after adjustment by covariates including the baseline estimated glomerular filtration rate.
Higher urinary -acetyl-β-D-glucosamidase level on admission was independently associated with worse clinical outcomes. Our findings indicate the potential value of assessing urinary -acetyl-β-D-glucosamidase on admission for further risk stratification in patients with acute heart failure.
尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶（-acetyl-β-D-glucosamidase）在急性心力衰竭中的预后意义尚未完全阐明。因此，本研究旨在探讨尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶是否与急性心力衰竭患者的不良预后相关。
我们研究了来自国家心血管病中心急性失代偿性心力衰竭注册登记研究的 708 例连续急性心力衰竭患者，这些患者入院时均有尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶数据。我们评估了入院时 -N- 乙酰-β-D- 氨基葡萄糖苷酶水平与全因死亡和心力衰竭恶化的复合终点之间的关系。心力衰竭恶化定义为在初始治疗稳定后需要加强静脉治疗（如利尿剂、血管扩张剂和正性肌力药）或开始机械支持，或出院后因心力衰竭再次入院。
在中位随访 763（四分位距 431-1028）天期间，较高的尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶与全因死亡和心力衰竭恶化事件的增加显著相关。此外，入院时尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶较高且估计肾小球滤过率较低的患者临床结局最差。多变量 Cox 回归分析显示，即使在校正包括基线估计肾小球滤过率在内的混杂因素后，入院时尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶仍与不良事件独立相关（风险比 1.19，95%置信区间 1.04-1.35）。
入院时较高的尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶水平与更差的临床结局独立相关。我们的研究结果表明，在急性心力衰竭患者中，评估入院时尿 -N- 乙酰-β-D- 氨基葡萄糖苷酶水平可能有助于进一步进行危险分层。
