Supplementary Material for: Trajectory of urine albumin-creatinine ratio in patients with acute heart failure (TACRAHF study)

Abstract Introduction: Albuminuria is prevalent in patients with chronic heart failure and is a risk factor for disease progression. However, its clinical meaning in acute heart failure remains elusive. This study analyzed the trajectory of urine albumin to creatinine ratio (UACR) between admission and discharge and its association with decongestion. Methods: In this prospective observational study, 63 patients were enrolled. UACR, B-type natriuretic peptide (BNP), and clinical congestion score (CCS) were obtained at admission and discharge. We used linear mixed regression analysis to compare changes in the natural logarithm of UACR (logUACR) and its association with changes in markers of decongestion. Estimates were reported as least squares mean (LSM) with their respective 95% CIs. Results: The median age of the study population was 87 years, 68.5% were women, and 69.8% had a left ventricular ejection fraction >50%. LogUACR at discharge significantly decreased in the overall population compared to admission [Δ –0.47, 95% CI -0.78 to -0.15, p-value=0.003]. The magnitude of UACR drop at discharge was associated with changes in surrogate markers of decongestion. Patients who showed a greater reduction in BNP at discharge exhibited a greater reduction in UACR (p=0.016). The same trend was also found with clinical decongestion, as assessed by changes in CCS; however, without achieving statistical significance (p=0.171). UACR change at discharge was not associated with changes in serum creatinine (p-value=0.923). Conclusion: In elderly patients with AHF and volume overload, the level of UACR significantly decreased upon discharge compared to admission. This reduction in UACR was closely linked to decreases in BNP.摘要 引言：白蛋白尿（albuminuria）在慢性心力衰竭患者中普遍存在，且是疾病进展的危险因素。然而，其在急性心力衰竭中的临床意义仍不明确。本研究分析了入院至出院期间尿白蛋白与肌酐比值（urine albumin to creatinine ratio, UACR）的动态变化轨迹，及其与充血缓解的相关性。 方法：本项前瞻性观察研究共纳入63例患者。分别于入院及出院时检测UACR、B型钠尿肽（B-type natriuretic peptide, BNP）及临床充血评分（clinical congestion score, CCS）。采用线性混合回归分析，比较UACR的自然对数转换值（logUACR）的变化情况，及其与充血缓解标志物变化的相关性。结果以最小二乘均数（least squares mean, LSM）及其对应的95%置信区间（95% CI）报告。 结果：本研究人群的中位年龄为87岁，女性占比68.5%，69.8%的患者左心室射血分数（left ventricular ejection fraction, LVEF）＞50%。与入院时相比，总体人群出院时的logUACR显著降低[Δ –0.47，95% CI：-0.78~-0.15，P=0.003]。出院时UACR的下降幅度与充血缓解替代标志物的变化相关：出院时BNP降幅更大的患者，其UACR降幅也更为显著（P=0.016）。通过CCS变化评估的临床充血缓解情况亦呈现相同趋势，但未达到统计学显著性（P=0.171）。出院时UACR的变化与血清肌酐的变化无相关性（P=0.923）。 结论：在合并容量超负荷的急性心力衰竭（acute heart failure, AHF）老年患者中，与入院时相比，出院时UACR水平显著降低。UACR的这一下降与BNP的降低密切相关。