Pre-Discharge Urinary Albumin-Creatinine Ratio as a Predictor of Post-Hospitalization Major Adverse Cardiovascular Events (MACEs) Due to Acute Heart Failure

Background: Acute heart failure (AHF) is a multifactorial syndrome associated with rehospitalization and higher mortality. Impaired renal function is one of non-cardiac comorbidities which aggravate the progression of heart failure (HF). Increased in urinary albumin-creatinine ratio (UACR) reflects decline of renal function. It also provides useful information for risk stratification and determining prognosis of HF patient. Methods: Patients with AHF who met inclusion-exclusion criteria were included in a prospective observational cohort study. After achieving decongestion state, we obtained early morning urine samples of these patients to examine pre-discharge UACR. We monitored patients within 60 days post-discharged. Demographic, clinical characteristics, comorbidities, laboratory and echocardiographic data were also collected. The outcomes studied were major cardiovascular events (MACEs), consisted of rehospitalization due to heart failure and/or cardiovascular mortality. Cut-off point of pre-discharge UACR was determined by ROC curves, Kaplan-Meier curve was used to assess survival of MACEs based on pre-discharge UACR values, and multivariate analysis using Cox Regression was performed using SPSS version 24.0.0.0. Results: A total of 70 samples were involved until the end of the study. The cut-off point of pre-discharge UACR was 46.5 mg/gram creatinine (AUC 0.653, sensitivity of 67.5% specificity of 66.7%). Subjects with pre-discharge UACR ≥46.5 mg/gram creatinine had a survival of 39.40% while those with a value <46.5 mg/gram creatinine had a survival of 73.0% (p = 0.003). Multivariate analysis showed that pre-discharge UACR ≥ 46.5 mg/gram creatinine was independently associated with an increased risk of MACEs within 60 days post-hospitalization due to AHF (adjusted HR 4.76; 95% CI 1,455-15,622; p=0.010). Conclusion: Pre-discharge UACR ≥ 46.5 mg/gram creatinine was independently associated as a predictor of MACEs within 60 days post-hospitalization due to AHF.