Albuminuria and Acute Heart Failure: A New Biomarker for Congestion and Follow-Up?

INTRODUCTION: This study evaluated the trajectory of the urine albumin-to-creatinine ratio (UACR) in patients hospitalized with acute heart failure (HF) from pre-admission (baseline), through hospital admission, discharge and 2 weeks post-discharge. We also assessed its association with congestion-related biomarkers, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), CA 125, and the neutrophil-to-lymphocyte (N/L) ratio. METHODS: Prospective, observational study including 99 consecutive patients admitted with acute HF. Blood and urine analyses were performed at admission, at discharge and 2 weeks post-discharge. Patients were stratified according to UACR at admission and the trajectories of UACR and biomarkers were evaluated. The clinical, analytical, and echocardiographic predictors of UACR were analysed. RESULTS: Mean age was 70.8 ± 12.2 years, 57% were men. At admission, albuminuria was present in 65.7% of patients (45.5% microalbuminuria, 20.2% macroalbuminuria, respectively). A higher UACR at admission was associated with diabetes, lower eGFR, previous HF admission, higher clinical congestion score, mixed or right-sided congestive phenotype, higher NT-proBNP, and CA 125 levels. The UACR worsened from baseline to admission and improved at discharge, reflecting the congestion dynamics. NT-proBNP, CA 125, and N/L ratio showed similar patterns. Independent predictors of higher UACR at admission were diabetes, reduced renal function, higher aspartate aminotransferase (AST) and lower vitamin D levels. In the mixed linear regression analysis, lower eGFR, and higher AST levels remained independently associated with UACR trajectory. Admission UACR correlated with congestion score and predicted higher in-hospital mortality and early HF readmissions (