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Urinary Alpha1-Microglobulin: A New Predictor for In-Hospital Mortality in Patients with ST-Segment Elevation
Hehe Cui1, Xiao Zhang2, Xiaosong Ding1
1Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Metabolic Disorder-Related Cardiovascular Disease, Beijing, China (mainland).
Abstract:
BACKGROUND Alpha1-microglobulin (A1MG) is a small molecular protein related to oxidation and inflammation. It exists in diverse body fluids, including urine. Results from urine tests are sometimes neglected when predicting in-hospital prognosis. It remains unclear whether urinary A1MG (UA1MG) can predict short-term prognosis of ST-elevated myocardial infarction (STEMI). MATERIAL AND METHODS A total of 1854 hospitalized patients with acute STEMI were retrospectively enrolled in our study. Medical records were used to obtain patient demographic and clinical information, UA1MG values (which were used to divide patients into groups of low, medium, or high), and other laboratory parameters. Principal clinical outcomes of interest were all-cause in-hospital deaths, cardiac deaths, and major adverse cardiac events (MACEs). RESULTS Among the 1854 enrolled patients, 43 (2.3%) died in the hospital, of which 33 (1.8%) were cardiac deaths. MACEs were noted in 113 patients (6.1%) during hospitalization. The group with the highest UA1MG value showed a significantly higher frequency of in-hospital deaths, cardiac deaths, and MACEs, compared to those of the lowest UA1MG value group (4.4% vs. 1.0%, P<0.001; 3.1% vs. 0.6%, P<0.005; and 8.6% vs. 4.7%, P=0.007, respectively). Multivariate regression analysis revealed that UA1MG levels (odds ratio 1.109, 95% confidence interval (CI) 1.027-1.197, P=0.008) independently predicted all-cause in-hospital mortality. A UA1MG value of 3.23 mg/dL was considered as an optimal cutoff point in STEMI to predict all-cause mortality after receiver operating characteristic curve analysis (area under the curve 0.73, 95% CI 0.65-0.80, P<0.001). CONCLUSIONS The UA1MG value at hospital admission could be an independent prognostic factor of all-cause in-hospital mortality in patients with STEMI.
Insights
Urinary Alpha1-microglobulin (UA1MG) levels at admission can predict in-hospital mortality in ST-elevated myocardial infarction (STEMI) patients. Higher UA1MG levels correlate with increased risks of death and major adverse cardiac events.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Prognostics
Background:
- Alpha1-microglobulin (A1MG) is linked to inflammation and oxidation.
- Urinary A1MG (UA1MG) is present in body fluids but its prognostic value in ST-elevated myocardial infarction (STEMI) is unclear.
- Urine test results are often overlooked in predicting hospital prognosis.
Purpose of the Study:
- To investigate the association between UA1MG levels and short-term prognosis in STEMI patients.
- To determine if UA1MG can serve as an independent predictor of in-hospital mortality and major adverse cardiac events (MACEs) in STEMI.
Main Methods:
- Retrospective analysis of 1854 hospitalized STEMI patients.
- Categorization of patients into low, medium, and high UA1MG groups based on admission values.
- Evaluation of in-hospital all-cause deaths, cardiac deaths, and MACEs as primary outcomes.
Main Results:
- Patients with the highest UA1MG levels exhibited significantly higher rates of in-hospital deaths (4.4% vs. 1.0%), cardiac deaths (3.1% vs. 0.6%), and MACEs (8.6% vs. 4.7%) compared to the lowest UA1MG group.
- Multivariate analysis confirmed UA1MG as an independent predictor of all-cause in-hospital mortality (OR 1.109, P=0.008).
- An optimal UA1MG cutoff of 3.23 mg/dL predicted all-cause mortality with an AUC of 0.73 (P<0.001).
Conclusions:
- Admission UA1MG levels are a significant independent prognostic factor for all-cause in-hospital mortality in STEMI patients.
- UA1MG shows potential as a readily accessible biomarker for risk stratification in acute myocardial infarction.
- Further research could explore UA1MG's role in guiding therapeutic strategies for STEMI management.
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