Key result
Higher discharge UACR predicts ~39% higher 1-year death or HF rehospitalization risk per SD in HFmrEF/HFpEF.
Why the study?
It was not established whether the prognostic value of albuminuria depends on measurement timing (admission vs discharge) and whether this relationship differs by ejection fraction phenotype.
Does discharge urine albumin-to-creatinine ratio (UACR) predict 1-year all-cause death or HF rehospitalization in patients with acute decompensated heart failure?
Cohort (n=290)
Does discharge urine albumin-to-creatinine ratio (UACR) predict 1-year all-cause death or HF rehospitalization in patients with acute decompensated heart failure?
Effect estimate: HR range 1.37-1.40
p-value: p=≤0.008
Discharge urine albumin-to-creatinine ratio independently predicts 1-year adverse outcomes in patients with HFmrEF/HFpEF, but not HFrEF, offering a potential tool for post-discharge risk stratification.
Discharge albuminuria may refine post-discharge stratification in HFmrEF/HFpEF; leaves open timing- and EF-specific thresholds.
BACKGROUND: Post-discharge risk stratification remains challenging in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), where natriuretic peptides incompletely capture residual renal and microvascular stress. Albuminuria integrates glomerular and microvascular injury, yet whether its prognostic value depends on measurement timing-admission versus discharge-and whether this relationship differs by ejection fraction (EF) phenotype, has not been established. METHODS: In 290 patients hospitalized for acute decompensated HF [126 HF with reduced ejection fraction (HFrEF), 164 HFmrEF/HFpEF], the urine albumin-to-creatinine ratio (UACR) was measured at admission and discharge. The primary outcome was the 1-year composite of all-cause death or HF rehospitalization. Sensitivity analyses sequentially adjusted for individual medication classes, and the interaction between UACR and EF phenotype was formally tested. RESULTS: UACR decreased markedly during hospitalization (median 96.8 to 24.7 mg/gCr; p < 0.001), yet residual albuminuria was greater in HFmrEF/HFpEF at discharge (28.5 mg/gCr vs 18.7 mg/gCr; p = 0.038). During a 1-year follow-up, 98 patients (34%) experienced the composite endpoint. Per 1-SD increase in log-transformed discharge UACR, discharge UACR was independently associated with outcomes in HFmrEF/HFpEF across all four medication-adjusted models (HR range 1.37-1.40, all p ≤ 0.008), whereas admission UACR lost significance after adjustment. No meaningful associations were observed in HFrEF. The interaction between discharge UACR and EF phenotype was of borderline significance after adjustment (p for interaction = 0.047). CONCLUSIONS: Discharge UACR independently predicts adverse outcomes in HFmrEF/HFpEF, with associations that remained consistent after adjustment for individual HF medication classes. Predischarge UACR measurement may refine post-discharge risk stratification in HFmrEF/HFpEF in addition to natriuretic peptides.
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Ohno et al. (2026) conducted a cohort in Acute decompensated heart failure (n=290). Discharge urine albumin-to-creatinine ratio (UACR) was evaluated on 1-year composite of all-cause death or HF rehospitalization (HR range 1.37-1.40, p=≤0.008). Discharge urine albumin-to-creatinine ratio independently predicted 1-year all-cause death or HF rehospitalization in HFmrEF/HFpEF (HR range 1.37-1.40, p≤0.008 per 1-SD increase).
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