尿白蛋白水平升高预测不合并糖尿病的射血分数降低的心力衰竭患者预后的价值

目的:分析入院时尿白蛋白水平(UAC)升高对不合并糖尿病的射血分数降低的心力衰竭(HFrEF)患者预后的评价价值.方法:入选2013年1月至2017年12月期间于北京水利医院内科住院的不合并糖尿病的HFrEF患者212例.留取患者入院后次日晨起首次中段尿检测UAC,以≥30 mg/L定义为UAC升高.出院后通过电话或门...

Prognostic Value of Elevated Urinary Albumin Concentration in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction Without Diabetes Mellitus

Objectives:To investigate the prognostic value of elevated urinary albumin concentration(UAC)in patients hospitalized with heart failure with reduced ejection fraction(HFrEF)without diabetes mellitus(DM).Methods:Patients hospitalized with HFrEF without DM in Department of Internal Medicine of Beijing Water Conservancy Hospital from January 2013 to December 2017 were enrolled.Midstream specimen of urine was obtained on the next morning after admission to determine UAC and elevated UAC was defined as UAC≥30 mg/L.After discharge,patients were followed-up until December 2020,and primary endpoint was all-cause death(ACD).Occurrence of ACD was compared between patients with elevated or normal UAC.Kaplan-Meier survival curve method with log-rank test was used to compare differences in post-discharge survival rates between these two groups.Multivariate Cox regression analysis was used to identify prognostic factors of ACD and evaluate the prognostic value of elevated UAC.Moreover,prognostic value of elevated UAC was compared between patients with estimated glomerular filtration rate(eGFR)<90 ml/(min·1.73 m²)and those with eGFR≥90 ml/(min·1.73 m²).Results:A total of 212 patients were enrolled in this study and elevated UAC was found in 69(32.5%)patients.During a follow-up of 28(10,54)months after discharge,66(31.1%)patients died.Incidence of ACD was significantly higher in patients with elevated UAC than patients with normal UAC(42.0%vs.25.9%,P=0.017).Multivariate Cox regression analysis showed that after adjusting for systolic blood pressure,NYHA classification,left ventricular end-diastolic diameter on admission,and application of angiotensin converting enzyme inhibitor(ACEI)or angiotensin receptor blocker(ARB)at discharge,elevated UAC remained as an independent predictor of post-discharge ACD(HR=2.424,95%CI:1.455-4.039,P=0.001).Furthermore,among patients with eGFR≥90 ml/(min·1.73m²)(n=125),Kaplan-Meier survival curve analysis showed a significant lower survival rate in patients with elevated UAC than those with normal UAC(P=0.032)and elevated UAC still served as an independent predictor of ACD after adjusting for other clinical parameters(adjusted HR=2.757,95%CI:1.339-5.675,P=0.006).However,among patients with eGFR<90 ml/(min·1.73 m²)(n=87),there was no significant difference in survival rate between those with elevated or normal UAC(P=0.504).Conclusions:Elevated UAC is an independent predictor of ACD after discharge in patients hospitalized with HFrEF without DM,especially in patients with preserved renal function.