尿白蛋白浓度升高可预测住院急性失代偿性心力衰竭患者的临床结局更差。
Elevated urinary albumin concentration predicts worse clinical outcomes in hospitalized acute decompensated heart failure patients.
机构信息
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
ESC Heart Fail. 2021 Aug;8(4):3037-3048. doi: 10.1002/ehf2.13399. Epub 2021 May 18.
OBJECTIVE
To investigate the prognostic value of elevated urinary albumin concentration (UAC) in hospitalized acute decompensated heart failure (ADHF) patients.
METHODS
We measured UAC at baseline in 1818 hospitalized ADHF patients who were admitted to our Heart Failure Center. All patients were followed up for a median period of 937.5 days. The primary endpoint was a composite of all-cause death or heart transplantation (HTx) or left ventricular assist device (LVAD) implantation.
RESULTS
In total, 41.5% of ADHF patients had albuminuria (UAC ≥ 20 mg/L). The median value of UAC was 15.5 mg/L. A total of 679 patients died or underwent HTx/LVAD during follow-up. The median UAC was significantly lower in non-HTx/LVAD survivors (14.3 mg/L) than in those who died or underwent HTx/LVAD (18.0 mg/L, P < 0.001). Compared with patients without albuminuria (reference, n = 1064), those with albuminuria had a 1.47-fold higher risk of all-cause death or HTx/LVAD (95% confidence interval [CI]:1.26-1.71, P < 0.001), with hazard ratios (HRs) of 1.42 (95% CI: 1.21-1.66) and 1.74 (95% CI: 1.33-2.26) in patients with microalbuminuria (20 mg/L ≤ UAC < 200 mg/L, n = 617) and macroalbuminuria (UAC ≥ 200 mg/L, n = 137), respectively (both P < 0.001). After adjustment for significant clinical risk factors, the albuminuria group had a higher risk of primary adverse events than the non-albuminuria group (HR = 1.28, 95% CI: 1.09-1.50, P = 0.003), with HRs of 1.27 [95% CI: 1.07-1.49] and 1.36 [95% CI: 1.01-1.84] in patients with microalbuminuria and macroalbuminuria, respectively (P = 0.006 and P = 0.041). The adjusted risk of primary adverse events also increased with the degree of albuminuria in the test for trend (HR = 1.21, 95% CI: 1.06-1.37, P for trend = 0.004). In the subgroup analysis, albuminuria had a significantly greater prognostic value for patients with left ventricular ejection fraction ≥ 40%, eGFR ≥ 60 mL/min/1.73 m , BUN/creatinine ratio ≥ 20 or NT-proBNP < 2098 pg/mL.
CONCLUSION
The presence of albuminuria evaluated by UAC predicts adverse clinical outcomes in hospitalized ADHF patients.
目的
探讨住院急性失代偿性心力衰竭（ADHF）患者尿白蛋白浓度（UAC）升高的预后价值。
方法
我们在我院心力衰竭中心收治的 1818 例住院 ADHF 患者中，于基线时测量 UAC。所有患者均随访中位数 937.5 天。主要终点为全因死亡或心脏移植（HTx）或左心室辅助装置（LVAD）植入的复合终点。
结果
共有 41.5%的 ADHF 患者存在白蛋白尿（UAC≥20mg/L）。UAC 的中位数为 15.5mg/L。在随访期间，共有 679 例患者死亡或接受 HTx/LVAD。非 HTx/LVAD 幸存者的 UAC 中位数明显低于死亡或接受 HTx/LVAD 的患者（14.3mg/L，P<0.001）。与无白蛋白尿的患者（参考组，n=1064）相比，白蛋白尿患者的全因死亡或 HTx/LVAD 风险增加 1.47 倍（95%置信区间：1.26-1.71，P<0.001），微量白蛋白尿（20mg/L≤UAC<200mg/L，n=617）和大量白蛋白尿（UAC≥200mg/L，n=137）患者的风险比（HRs）分别为 1.42（95%CI：1.21-1.66）和 1.74（95%CI：1.33-2.26）（均 P<0.001）。在校正了显著的临床危险因素后，白蛋白尿组的主要不良事件风险高于无白蛋白尿组（HR=1.28，95%CI：1.09-1.50，P=0.003），微量白蛋白尿和大量白蛋白尿患者的 HR 分别为 1.27（95%CI：1.07-1.49）和 1.36（95%CI：1.01-1.84）（P=0.006 和 P=0.041）。在趋势检验中，主要不良事件的调整风险也随白蛋白尿程度的增加而增加（HR=1.21，95%CI：1.06-1.37，P 趋势=0.004）。在亚组分析中，UAC 评估的白蛋白尿对左心室射血分数≥40%、eGFR≥60mL/min/1.73m、BUN/肌酐比值≥20 或 NT-proBNP<2098pg/mL 的患者具有更显著的预后价值。
结论
UAC 评估的白蛋白尿可预测住院 ADHF 患者的不良临床结局。
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