{"title":"Prognostic values of proteinuria in patients with acute heart failure.","authors":"Yuka Akama, Yuya Matsue, Daichi Maeda, Taishi Dotare, Tsutomu Sunayama, Takashi Iso, Yudai Fujimoto, Taisuke Nakade, Shoichiro Yatsu, Sayaki Ishiwata, Yutaka Nakamura, Shoko Suda, Takao Kato, Masaru Hiki, Takatoshi Kasai, Tohru Minamino","doi":"10.1016/j.jjcc.2025.01.010","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Renal dysfunction is significantly associated with poor prognosis in patients with heart failure. However, the prognostic significance of proteinuria as a potential marker of an impaired glomerular filtration barrier in acute heart failure (AHF) remains unclear. We aimed to investigate the prognostic value of urinary protein/creatinine ratio (PCR) in patients with AHF.</p><p><strong>Methods: </strong>Urinary protein levels measured at admission were adjusted for urinary creatinine concentrations in 346 patients (75 ± 13 years; 61 % men) with AHF. Patients were categorized based on urinary PCR, adhering to the Japanese chronic kidney disease (CKD) guideline cut-offs for CKD staging: A1 (<0.15 g/gCr), A2 (0.15-0.49 g/gCr), and A3 (≥0.5 g/gCr). The primary endpoint was all-cause mortality.</p><p><strong>Results: </strong>Overall, there were 85, 126, and 135 patients in the A1, A2, and A3 groups, respectively. Groups A2 and A3 were associated with lower hemoglobin levels, higher blood urea nitrogen and N-terminal pro-B-type natriuretic peptide levels, and poor renal function. Moreover, groups A2 and A3 had high cystatin C, alpha 1 microglobulin, and urinary liver-type fatty acid-binding protein (L-FABP) levels. Urinary PCR correlated more with tubular markers, alpha 1-microglobulin, and L-FABP than with the glomerular marker cystatin C. Over a median follow-up period of 434 (interquartile range: 89-753) days, 72 deaths occurred. Elevated urinary PCR was associated with higher mortality rates (log-rank test, p < 0.001), even after adjusting for other variables [A2 vs. A1: hazard ratio (HR) 2.59, 95 % confidence interval (CI) 0.71-9,55, p = 0.15; A3 vs. A1: HR 4.40, 95 % CI 1.17-16.6, p = 0.029].</p><p><strong>Conclusions: </strong>Elevated urinary PCR is more prevalent in patients with AHF and is associated with a higher risk of all-cause mortality, independent of covariates, including glomerular function. Thus, urinary PCR at admission should provide prognostic information independent of glomerular function.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jjcc.2025.01.010","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Renal dysfunction is significantly associated with poor prognosis in patients with heart failure. However, the prognostic significance of proteinuria as a potential marker of an impaired glomerular filtration barrier in acute heart failure (AHF) remains unclear. We aimed to investigate the prognostic value of urinary protein/creatinine ratio (PCR) in patients with AHF.
Methods: Urinary protein levels measured at admission were adjusted for urinary creatinine concentrations in 346 patients (75 ± 13 years; 61 % men) with AHF. Patients were categorized based on urinary PCR, adhering to the Japanese chronic kidney disease (CKD) guideline cut-offs for CKD staging: A1 (<0.15 g/gCr), A2 (0.15-0.49 g/gCr), and A3 (≥0.5 g/gCr). The primary endpoint was all-cause mortality.
Results: Overall, there were 85, 126, and 135 patients in the A1, A2, and A3 groups, respectively. Groups A2 and A3 were associated with lower hemoglobin levels, higher blood urea nitrogen and N-terminal pro-B-type natriuretic peptide levels, and poor renal function. Moreover, groups A2 and A3 had high cystatin C, alpha 1 microglobulin, and urinary liver-type fatty acid-binding protein (L-FABP) levels. Urinary PCR correlated more with tubular markers, alpha 1-microglobulin, and L-FABP than with the glomerular marker cystatin C. Over a median follow-up period of 434 (interquartile range: 89-753) days, 72 deaths occurred. Elevated urinary PCR was associated with higher mortality rates (log-rank test, p < 0.001), even after adjusting for other variables [A2 vs. A1: hazard ratio (HR) 2.59, 95 % confidence interval (CI) 0.71-9,55, p = 0.15; A3 vs. A1: HR 4.40, 95 % CI 1.17-16.6, p = 0.029].
Conclusions: Elevated urinary PCR is more prevalent in patients with AHF and is associated with a higher risk of all-cause mortality, independent of covariates, including glomerular function. Thus, urinary PCR at admission should provide prognostic information independent of glomerular function.
期刊介绍：
The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.
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