Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Metabolic Disorder-Related Cardiovascular Disease, Beijing, China (mainland).
Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (mainland).
Med Sci Monit. 2021 Jan 18;27:e927958. doi: 10.12659/MSM.927958.
BACKGROUND Alpha1-microglobulin (A1MG) is a small molecular protein related to oxidation and inflammation. It exists in diverse body fluids, including urine. Results from urine tests are sometimes neglected when predicting in-hospital prognosis. It remains unclear whether urinary A1MG (UA1MG) can predict short-term prognosis of ST-elevated myocardial infarction (STEMI). MATERIAL AND METHODS A total of 1854 hospitalized patients with acute STEMI were retrospectively enrolled in our study. Medical records were used to obtain patient demographic and clinical information, UA1MG values (which were used to divide patients into groups of low, medium, or high), and other laboratory parameters. Principal clinical outcomes of interest were all-cause in-hospital deaths, cardiac deaths, and major adverse cardiac events (MACEs). RESULTS Among the 1854 enrolled patients, 43 (2.3%) died in the hospital, of which 33 (1.8%) were cardiac deaths. MACEs were noted in 113 patients (6.1%) during hospitalization. The group with the highest UA1MG value showed a significantly higher frequency of in-hospital deaths, cardiac deaths, and MACEs, compared to those of the lowest UA1MG value group (4.4% vs. 1.0%, P<0.001; 3.1% vs. 0.6%, P<0.005; and 8.6% vs. 4.7%, P=0.007, respectively). Multivariate regression analysis revealed that UA1MG levels (odds ratio 1.109, 95% confidence interval (CI) 1.027-1.197, P=0.008) independently predicted all-cause in-hospital mortality. A UA1MG value of 3.23 mg/dL was considered as an optimal cutoff point in STEMI to predict all-cause mortality after receiver operating characteristic curve analysis (area under the curve 0.73, 95% CI 0.65-0.80, P<0.001). CONCLUSIONS The UA1MG value at hospital admission could be an independent prognostic factor of all-cause in-hospital mortality in patients with STEMI.
α1-微球蛋白（A1MG）是一种与氧化和炎症有关的小分子蛋白。它存在于多种体液中，包括尿液。尿液检测结果在预测住院预后时有时会被忽视。目前尚不清楚尿 A1MG（UA1MG）能否预测 ST 段抬高型心肌梗死（STEMI）的短期预后。
回顾性纳入 1854 例住院急性 STEMI 患者。通过病历获取患者的人口统计学和临床信息、UA1MG 值（用于将患者分为低、中、高组）和其他实验室参数。主要临床终点为全因住院死亡、心源性死亡和主要不良心脏事件（MACE）。
在纳入的 1854 例患者中，43 例（2.3%）住院期间死亡，其中 33 例（1.8%）为心源性死亡。住院期间发生 MACE 的患者有 113 例（6.1%）。与 UA1MG 值最低组相比，UA1MG 值最高组的住院死亡、心源性死亡和 MACE 发生率显著更高（4.4%比 1.0%，P<0.001；3.1%比 0.6%，P<0.005；8.6%比 4.7%，P=0.007）。多变量回归分析显示，UA1MG 水平（比值比 1.109，95%置信区间（CI）1.027-1.197，P=0.008）是全因住院死亡率的独立预测因素。经受试者工作特征曲线分析，UA1MG 值为 3.23mg/dL 时可作为预测 STEMI 全因死亡率的最佳截断值（曲线下面积 0.73，95%CI 0.65-0.80，P<0.001）。
入院时的 UA1MG 值可能是 STEMI 患者全因住院死亡率的独立预后因素。
