Abstract 12640: Urine Albumin-to-Creatinine Ratio Outperforms Other Biomarkers in Predicting Death
Background: Risk stratification plays an important role in evaluating patients with no known cardiovascular disease (CVD). Few studies have investigated the role of high-normal urine albumin-to-creatinine ratio as a predictive tool for mortality (normal range defined as <30 mg/g). Our study aims to measure the relative effectiveness of a high-normal urine albumin-to-creatinine ratio in predicting mortality when compared to traditional biomarkers in a primary prevention population.
Methods: 8123 consecutive primary prevention patients evaluated at the Cleveland Clinic Preventive Cardiology Clinic between January 1996 and September 2012 were included in the analysis. Of this patient cohort, 12% had diabetes while 43% had hypertension. The primary outcome was all-cause mortality.
Results: A urine albumin-to-creatinine ratio above the median (>6 mg/g) independently predicts a 4.4-fold increase in death at 8 years (Hazard Ratio [95% confidence interval] 4.45 [2.56-7.73], p<0.001). When compared to traditional biomarkers such as hsCRP, homocysteine, fibrinogen and lipids, urine albumin-to-creatinine ratio was a better predictor of mortality with a C-index of 0.72. The urine albumin-to-creatinine ratio also improved the predictive ability of the Framingham risk score components, with an increase in C-index from 0.77 to 0.84, and a Net Reclassification Index (NRI) of 64%.
Conclusions: The urine albumin-to-creatinine ratio is a reliable predictor of mortality in a primary cardiac prevention population. In an era of rising medical costs, the urine albumin-to-creatinine could be used as a relatively non-costly predictor of mortality in this population.
Author Disclosures: R. Lahoud: None. L. Cho: None. D. Brennan: None.
- © 2014 by American Heart Association, Inc.