Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Department of Cardiovascular Disease, Universit de Lorraine, Inserm INI-CRCT, CHRU, 30 rue Lionnois, 54000 Nancy, France.
Eur Heart J. 2023 Feb 1;44(5):368-380. doi: 10.1093/eurheartj/ehac528.
Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserved ejection fractions were evaluated.
Two thousand three hundred and fifteen patients included in the index cohort of BIOSTAT-CHF were evaluated and findings were validated in the independent BIOSTAT-CHF validation cohort (1431 patients). Micro-albuminuria and macro-albuminuria were defined as urinary albumincreatinine ratio (UACR) 30 mg/gCr and 300 mg/gCr in spot urines, respectively. The prevalence of micro- and macro-albuminuria was 35.4 and 10.0, respectively. Patients with albuminuria had more severe heart failure, as indicated by inclusion during admission, higher New York Heart Association functional class, more clinical signs and symptoms of congestion, and higher concentrations of biomarkers related to congestion, such as biologically active adrenomedullin, cancer antigen 125, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (all P 0.001). The presence of albuminuria was associated with increased risk of mortality and heart failure (re)hospitalization in both cohorts. The strongest independent association with log UACR was found for log NT-proBNP (standardized regression coefficient 0.438, 95 confidence interval 0.350.53, P 0.001). Hierarchical clustering analysis demonstrated that UACR clusters with markers of congestion and less with indices of renal function. The validation cohort yielded similar findings.
In patients with new-onset or worsening heart failure, albuminuria is consistently associated with clinical, echocardiographic, and circulating biomarkers of congestion.
蛋白尿在心力衰竭患者中很常见，并且与预后较差相关。心力衰竭患者蛋白尿的潜在病理生理机制仍不完全清楚。本研究旨在评估射血分数降低和保留的心力衰竭患者的临床特征和生物标志物特征与白蛋白尿的关系。
在 BIOSTAT-CHF 指数队列中纳入了 2315 例患者，并在独立的 BIOSTAT-CHF 验证队列（1431 例患者）中进行了验证。微量白蛋白尿和大量白蛋白尿分别定义为尿白蛋白/肌酐比值（UACR）在尿液中为 30mg/gCr 和 300mg/gCr。微量白蛋白尿和大量白蛋白尿的患病率分别为 35.4%和 10.0%。白蛋白尿患者的心力衰竭更为严重，表现在入院时即被纳入、纽约心脏协会功能分级更高、更多的充血临床体征和症状，以及更高浓度的与充血相关的生物标志物，如生物活性肾上腺髓质素、癌抗原 125 和 N 末端 pro-B 型利钠肽（NT-proBNP）（均 P<0.001）。在两个队列中，白蛋白尿的存在与死亡率和心力衰竭（再）住院风险增加相关。与 logUACR 相关性最强的是 logNT-proBNP（标准化回归系数 0.438，95%置信区间 0.350.53，P<0.001）。层次聚类分析表明，UACR 与充血标志物聚类，与肾功能指标聚类较少。验证队列也得出了类似的结果。
在新发或恶化的心力衰竭患者中，白蛋白尿与充血的临床、超声心动图和循环生物标志物始终相关。
