Division of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
Shantou University Medical College, Shantou, Guangdong, China.
Int Urol Nephrol. 2023 Jul;55(7):1811-1819. doi: 10.1007/s11255-023-03499-z. Epub 2023 Feb 9.
Traditional cutoff values of urinary albumin-to-creatinine ratio (UACR) for predicting mortality have recently been challenged. In this study, we investigated the optimal threshold of UACR for predicting long-term cardiovascular and non-cardiovascular mortality in the general population.
Data for 25,302 adults were extracted from the National Health and Nutrition Examination Survey (2005-2014). Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of UACR for cardiovascular and non-cardiovascular mortality. A Cox regression model was established to examine the association between UACR and cardiovascular and non-cardiovascular mortality. X-tile was used to estimate the optimal cutoff of UACR.
The UACR had acceptable predictive value for both cardiovascular (AUC (95% CI) for 1-year, 3-year and 5-year mortality, respectively: 0.769 (0.711-0.828), 0.764 (0.722-0.805) and 0.763 (0.730-0.795)) and non-cardiovascular (AUC (95% CI) for 1-year, 3-year and 5-year mortality, respectively: 0.772 (0.681-0.764), 0.708 (0.686-0.731) and 0.708 (0.690-0.725)) mortality. The optimal cutoff values were 16 and 30 mg/g for predicting long-term cardiovascular and non-cardiovascular mortality, respectively. Both cutoffs of UACR had acceptable specificity (0.785-0.891) in predicting long-term mortality, while the new proposed cutoff (16 mg/g) had higher sensitivity. The adjusted hazard ratios of cardiovascular and non-cardiovascular mortality for the high-risk group were 2.50 (95% CI 1.96-3.18, P < 0.001) and 1.92 (95% CI 1.70-2.17, P < 0.001), respectively.
Compared to the traditional cutoff value (30 mg/g), a UACR cutoff of 16 mg/g may be more sensitive for identifying patients at high risk for cardiovascular mortality in the general population.
传统的尿白蛋白与肌酐比值（UACR）截断值用于预测死亡率最近受到了挑战。本研究旨在探讨 UACR 预测普通人群长期心血管和非心血管死亡率的最佳截断值。
从 2005-2014 年的全国健康和营养调查（NHANES）中提取了 25302 名成年人的数据。采用受试者工作特征（ROC）曲线分析评估 UACR 对心血管和非心血管死亡率的预测价值。建立 Cox 回归模型来检验 UACR 与心血管和非心血管死亡率之间的关系。X-tile 用于估计 UACR 的最佳截断值。
UACR 对心血管（1 年、3 年和 5 年死亡率的 AUC（95%CI）分别为：0.769（0.711-0.828）、0.764（0.722-0.805）和 0.763（0.730-0.795））和非心血管（1 年、3 年和 5 年死亡率的 AUC（95%CI）分别为：0.772（0.681-0.764）、0.708（0.686-0.731）和 0.708（0.690-0.725））死亡率均具有可接受的预测价值。预测长期心血管和非心血管死亡率的最佳截断值分别为 16 和 30mg/g。UACR 的两个截断值在预测长期死亡率方面均具有可接受的特异性（0.785-0.891），而新提出的截断值（16mg/g）具有更高的敏感性。心血管和非心血管死亡率高危组的调整后危害比分别为 2.50（95%CI 1.96-3.18，P<0.001）和 1.92（95%CI 1.70-2.17，P<0.001）。
与传统截断值（30mg/g）相比，UACR 截断值为 16mg/g 可能更敏感地识别普通人群中心血管死亡率高危患者。
