Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
BMJ Open. 2021 Sep 15;11(9):e049371. doi: 10.1136/bmjopen-2021-049371.
The semiquantitative urine dipstick test is a simple and convenient method that is available in the smallest community-based healthcare clinics. We sought to clarify the prognostic significance of dipstick proteinuria in patients with heart failure (HF) with preserved ejection fraction (HFpEF).
A rospective mlticente obervational stdy of patens with eart ailure with reserved jection raction (PURSUIT-HFpEF) registry.
We assessed 851 discharged-alive patients in the PURSUIT-HFpEF registry who were initially hospitalised due to an acute decompensated HFpEF (EF≥50%) and elevated N-terminal-pro-brain natriuretic peptide (≥400 ng/L) at Osaka University Hospital and other 30 affiliated hospitals in the Kansai region of Japan. Patients received a urine dipstick test, and were divided into two groups according to the absence or presence of proteinuria. A trace or more of dipstick proteinuria was defined as the presence of proteinuria.
A composite of cardiac death or HF rehospitalisation.
Median age was 83 years and 473 patients (55.6%) were female. Five hundred and two patients (59%) were proteinuria (-) and 349 patients (41%) were proteinuria (+). The composite endpoint and HF rehospitalisation occurred more often in proteinuria (+) individuals than proteinuria (-) individuals (log-rank p=0.006 and p=0.007, respectively); but cardiac death did not (log-rank p=0.139). Multivariable Cox regression analysis showed that the presence of proteinuria was associated with the composite endpoint (HR: 1.47, 95% CI 1.07 to 2.01, p=0.016), and HF rehospitalisation (HR: 1.48, 95% CI 1.07 to 2.05, p=0.020), but not with cardiac death (HR: 1.52, 95% CI 0.83 to 2.76, p=0.172).
Dipstick proteinuria may be a prognostic marker in patients with HFpEF. Evaluation of proteinuria by a urine dipstick test may be a simple but useful method for risk stratification in HFpEF.
UMIN-CTR ID: UMIN000021831.
半定量尿试纸检测是一种简单方便的方法，即使在最小的社区医疗机构也能获得。我们旨在明确在射血分数保留的心力衰竭（HFpEF）患者中，尿试纸蛋白检测的预后意义。
一项前瞻性、多中心观察性研究，纳入了在大阪大学医院和日本关西地区其他 30 家附属医院因急性失代偿性 HFpEF（EF≥50%）和升高的 N 端脑利钠肽前体（≥400ng/L）而初次住院的 PURSUIT-HFpEF 登记研究中的 851 例存活出院患者。患者接受尿试纸检测，并根据蛋白尿的有无分为两组。尿试纸蛋白检测结果为微量或以上定义为蛋白尿阳性。
心脏死亡或心力衰竭再住院的复合终点。
中位年龄为 83 岁，473 例（55.6%）为女性。502 例（59%）患者尿试纸蛋白（-），349 例（41%）患者尿试纸蛋白（+）。蛋白尿（+）患者的复合终点和心力衰竭再住院发生率高于蛋白尿（-）患者（log-rank p=0.006 和 p=0.007），但心脏死亡发生率无差异（log-rank p=0.139）。多变量 Cox 回归分析显示，蛋白尿的存在与复合终点（HR：1.47，95%CI 1.07 至 2.01，p=0.016）和心力衰竭再住院（HR：1.48，95%CI 1.07 至 2.05，p=0.020）相关，但与心脏死亡无关（HR：1.52，95%CI 0.83 至 2.76，p=0.172）。
尿试纸蛋白检测可能是 HFpEF 患者的预后标志物。尿试纸检测蛋白尿可能是 HFpEF 患者进行危险分层的一种简单而有用的方法。
UMIN-CTR ID：UMIN000021831。
