尿白蛋白-肌酐比值是动脉粥样硬化性心血管疾病患者长期死亡率的独立预测指标：倾向得分匹配研究：UACR 与 ASCVD 的长期死亡率。

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2024-12-18 DOI:10.1016/j.ajpc.2024.100920

Houyong Zhu , Chao Yang , Xiao Liu , Xiaoqun Xu , Qilan Chen , Xiaojiang Fang , Jinyu Huang , Tielong Chen

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引用次数: 0

摘要

背景和目的：动脉粥样硬化性心血管疾病（ASCVD）是导致死亡的主要原因之一，尽管尿白蛋白与肌酐比值（UACR）与心血管风险之间的关联已得到确认，但UACR对ASCVD患者长期生存的具体影响仍未完全了解。本研究的目的是探讨UACR对ASCVD患者全因死亡长期风险的影响。方法：本研究纳入1999年至2018年国家健康与营养检查调查（NHANES）的ASCVD患者。截至2019年12月31日，死亡率结果通过与国家死亡指数的联系来确定。UACR风险分为3个级别：0组（UACR < 30 mg/g）、1组（30-300 mg/g）和2组（30-300 mg/g）。主要结局为全因死亡率，心血管死亡率为次要结局。Cox比例风险，校正人口统计学因素、传统心血管危险因素和ASCVD的二级预防药物，用于分析结果的累积风险。采用倾向评分匹配进行风险调整，并根据慢性冠状动脉综合征（CCS）、中风、心力衰竭和非心力衰竭的队列进行敏感性分析。结果：在中位随访10年的1737例患者中，记录了1026例全因死亡和351例心血管死亡。全模型调整后，较高的UACR水平与全因死亡风险增加相关(第一组：风险比（HR）， 1.601；95%置信区间（CI）， 1.382-1.855；第二组：HR， 2.378；95% ci, 1.884-3.001；趋势P < 0.001)和心血管死亡率(第一组：HR， 2.080；95% ci, 1.631-2.652；第二组：HR， 2.883；95% ci, 1.951-4.260；趋势P均< 0.001)。倾向评分匹配证实了这些发现，显示高危UACR组的全因死亡风险显著升高(截止值为30 mg/g: HR， 1.468 (95% CI, 1.254-1.719), P < 0.001；临界值为300 mg/g: HR为1.935 (95% CI为1.399 ~ 2.675),P < 0.001)。所有敏感性分析均与整个队列的结果一致。结论：UACR是预测ASCVD患者长期预后的重要预后指标，其影响与eGFR无关。

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Urinary albumin-to-creatinine ratio as an independent predictor of long-term mortality in atherosclerotic cardiovascular disease patients: A propensity score-matched study

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Urinary albumin-to-creatinine ratio as an independent predictor of long-term mortality in atherosclerotic cardiovascular disease patients: A propensity score-matched study

Background and Aims

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality, and while the association between the urinary albumin-to-creatinine ratio (UACR) and cardiovascular risk is recognized, the specific impact of UACR on the long-term survival of ASCVD patients remains not fully understood. The aim of this study is to investigate the influence of UACR on the long-term risk of all-cause mortality in patients with ASCVD.

Methods

This study included ASCVD patients from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Mortality outcomes were ascertained by linkage to the National Death Index as of December 31, 2019. UACR risk was stratified into three levels: Group 0 (UACR < 30 mg/g), Group 1 (30–300 mg/g), and Group 2 (>300 mg/g). The primary outcome was all-cause mortality, with cardiovascular mortality as a secondary outcome. Cox proportional hazards, adjusted for demographic factors, traditional cardiovascular risk factors, and secondary prevention medications for ASCVD, were used to analyze the cumulative risk of outcomes. Propensity score matching was employed for risk adjustment, and sensitivity analyses were conducted based on cohorts with chronic coronary syndrome (CCS), stroke, heart failure, and non-heart failure.

Results

Among the 1,737 patients with a median follow-up of 10 years, 1,026 all-cause deaths and 351 cardiovascular deaths were recorded. After full model adjustment, higher UACR levels were associated with increased risks of all-cause mortality (Group 1: hazard ratio (HR), 1.601; 95 % confidence interval (CI), 1.382–1.855; Group 2: HR, 2.378; 95 % CI, 1.884–3.001; both P < 0.001 for trend) and cardiovascular mortality (Group 1: HR, 2.080; 95 % CI, 1.631–2.652; Group 2: HR, 2.883; 95 % CI, 1.951–4.260; both P < 0.001 for trend). Propensity score matching confirmed these findings, showing significantly elevated all-cause mortality risks in high-risk UACR groups (with a cutoff of 30 mg/g: HR, 1.468 (95 %CI, 1.254–1.719), P < 0.001; with a cutoff of 300 mg/g: HR, 1.935 (95 %CI, 1.399–2.675), P < 0.001). All sensitivity analyses were consistent with the results of the overall cohort.