Albuminuria and acute heart failure. Prognostic implications and short-term mortality

Abstract Introduction Albuminuria is a recognized risk factor for cardiovascular disease and heart failure (HF). Recently, the urine albumin/creatinine ratio (UACR) has been associated with congestion in HF. However, there is limited evidence about its impact during an acute heart failure (AHF) admission. Purpose To analyze the impact of the UACR and its association with other biomarkers during an AHF admission and after discharge. Methods In this prospective and observational study, one hundred consecutive patients with AHF admitted to the Cardiology Department from February to June 2024 were included. Blood and urine tests were performed on admission, discharge, and two weeks after discharge. Patients were classified in three groups according to the admission albuminuria: grade 1 (albuminuria 30 mg/g), grade 2 (30-300 mg/g or microalbuminuria), and grade 3 (300 mg/g or macroalbuminuria). Results Patients mean age was 70.8 years, 43% were women. 52% of patients had reduced HF, 33% preserved HF, 15% mildly reduced HF. According to the albumin/creatinine ratio, 34% had grade I, 45% grade 2 and 20% grade 3. Patients in grade 2 - 3 had more comorbidities, higher previous albuminuria levels and had a higher prior admission rate for HF (Figure 1). On admission, patients with mixed/right congestion phenotype had significantly greater levels of albuminuria compared to the left phenotype (p=0.046). Patients in grades 2 and 3 had a trend towards worse renal function, higher levels of parathyroid hormone and lower vitamin D. No differences were observed in liver function. In Figure 2, we can observe the trend of UACR, NT-proBNP, CA 12.5 and neutrophil-to-lymphocyte ratio (NRL) according to the UACR groups at admission. We observe a worsening of albuminuria with congestion, with subsequent improvement after decongestion. Patients in groups 2-3 had higher cardiac biomarkers regardless the time of measurement. Echocardiographic data show group 3 had a trend towards lower left ventricular ejection fraction and tricuspid annular plane systolic excursion/systolic pulmonary artery pressure coupling (TAPSE/PAPs ratio). Patients in groups 2-3 had higher early mortality or HF readmission one month after discharge than group 1. Conclusions The presence of albuminuria increases during AHF and rapidly decreasing after decongestion. Patients with higher albuminuria on admission have more comorbidities, more systemic congestion, worse TAPSE/PAPs coupling and increased mortality during hospitalization and at one-month post discharge. A longer follow-up and sample size is needed to determine the impact of albuminuria on HF admissions and mortality.Baseline characteristic at admission Trajectory of UACR according biomarkers