Sehtman-Shachar Dvora R, Yanuv Ilan, Schechter Meir, Fishkin Alisa, Aharon-Hananel Genya, Leibowitz Gil, Rozenberg Aliza, Mosenzon Ofri
Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Centre, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Diabetes Obes Metab. 2024 Oct;26(10):4225-4240. doi: 10.1111/dom.15752. Epub 2024 Jul 17.
To assess the association between urinary albumin-to-creatinine ratio (UACR) categories within the normal range with mortality and adverse cardiovascular outcomes.
PubMed and Embase were systematically searched for real-world evidence studies. Studies were manually evaluated according to predefined eligibility criteria. We included prospective and retrospective cohort studies of the association between UACR categories <30 mg/g and cardiovascular outcomes or mortality. Published information regarding study design, participants, UACR categorization, statistical methods, and results was manually collected. Two UACR categorization approaches were defined: a two-category (UACR <10 mg/g vs. 10-30 mg/g) and a three-category division (UACR <5 mg/g vs. 5-10 and 10-30 mg/g). A random effects meta-analysis was performed on studies eligible for the meta-analysis.
In total, 22 manuscripts were identified for the systematic review, 15 of which were eligible for the meta-analysis. The results suggest an association between elevated UACR within the normal to mildly increased range and higher risks of all-cause mortality, cardiovascular death, and coronary heart disease, particularly in the range of 10-30 mg/g. Compared with UACR <10 mg/g, the hazard ratio [HR (95% confidence interval, CI)] for UACR between 10 and 30 mg/g was 1.41 (1.15, 1.74) for all-cause mortality and 1.56 (1.23, 1.98) for coronary heart disease. Compared with UACR <5 mg/g, the risk of cardiovascular mortality for UACR between 10 and 30 mg/g was more than twofold [HR (95% CI): 2.12 (1.61, 2.80)]. Intermediate UACR (5-10 mg/g) was also associated with a higher risk of all-cause mortality [HR (95% CI): 1.14 (1.05, 1.24)] and cardiovascular mortality [HR (95% CI): 1.50 (1.14, 1.99)].
We propose considering higher UACR within the normoalbuminuric range as a prognostic factor for cardiovascular morbidity and mortality. Our findings underscore the clinical significance of even mild increases in albuminuria.
评估正常范围内尿白蛋白与肌酐比值（UACR）类别与死亡率及不良心血管结局之间的关联。
系统检索PubMed和Embase以获取真实世界证据研究。根据预先定义的纳入标准对研究进行人工评估。我们纳入了关于UACR类别<30mg/g与心血管结局或死亡率之间关联的前瞻性和回顾性队列研究。人工收集已发表的关于研究设计、参与者、UACR分类、统计方法及结果的信息。定义了两种UACR分类方法：两类（UACR<10mg/g与10 - 30mg/g）和三类划分（UACR<5mg/g与5 - 10mg/g以及10 - 30mg/g）。对符合荟萃分析条件的研究进行随机效应荟萃分析。
总共识别出22篇用于系统评价的手稿，其中15篇符合荟萃分析条件。结果表明，正常至轻度升高范围内UACR升高与全因死亡率、心血管死亡及冠心病的较高风险相关，特别是在10 - 30mg/g范围内。与UACR<10mg/g相比，UACR在10至30mg/g之间时，全因死亡率的风险比[HR（95%置信区间，CI）]为1.41（1.15，1.74），冠心病的风险比为1.56（1.23，1.98）。与UACR<5mg/g相比，UACR在10至30mg/g之间时心血管死亡风险增加两倍多[HR（95%CI）：2.12（1.61，2.80）]。中等UACR（5 - 10mg/g）也与全因死亡率[HR（95%CI）：1.14（1.05，1.24）]和心血管死亡率[HR（95%CI）：1.50（1.14，1.99）]的较高风险相关。
我们建议将正常白蛋白尿范围内较高的UACR视为心血管发病和死亡的一个预后因素。我们的研究结果强调了即使是轻度蛋白尿增加的临床意义。
