Abstract：
OBJECTIVE: To assess the association between urinary albumin-to-creatinine ratio (UACR) categories within the normal range with mortality and adverse cardiovascular outcomes.
METHODS: PubMed and Embase were systematically searched for real-world evidence studies. Studies were manually evaluated according to predefined eligibility criteria. We included prospective and retrospective cohort studies of the association between UACR categories <30 mg/g and cardiovascular outcomes or mortality. Published information regarding study design, participants, UACR categorization, statistical methods, and results was manually collected. Two UACR categorization approaches were defined: a two-category (UACR <10 mg/g vs. 10-30 mg/g) and a three-category division (UACR <5 mg/g vs. 5-10 and 10-30 mg/g). A random effects meta-analysis was performed on studies eligible for the meta-analysis.
RESULTS: In total, 22 manuscripts were identified for the systematic review, 15 of which were eligible for the meta-analysis. The results suggest an association between elevated UACR within the normal to mildly increased range and higher risks of all-cause mortality, cardiovascular death, and coronary heart disease, particularly in the range of 10-30 mg/g. Compared with UACR <10 mg/g, the hazard ratio [HR (95% confidence interval, CI)] for UACR between 10 and 30 mg/g was 1.41 (1.15, 1.74) for all-cause mortality and 1.56 (1.23, 1.98) for coronary heart disease. Compared with UACR <5 mg/g, the risk of cardiovascular mortality for UACR between 10 and 30 mg/g was more than twofold [HR (95% CI): 2.12 (1.61, 2.80)]. Intermediate UACR (5-10 mg/g) was also associated with a higher risk of all-cause mortality [HR (95% CI): 1.14 (1.05, 1.24)] and cardiovascular mortality [HR (95% CI): 1.50 (1.14, 1.99)].
CONCLUSIONS: We propose considering higher UACR within the normoalbuminuric range as a prognostic factor for cardiovascular morbidity and mortality. Our findings underscore the clinical significance of even mild increases in albuminuria.
METHODS: PubMed and Embase were systematically searched for real-world evidence studies. Studies were manually evaluated according to predefined eligibility criteria. We included prospective and retrospective cohort studies of the association between UACR categories <30 mg/g and cardiovascular outcomes or mortality. Published information regarding study design, participants, UACR categorization, statistical methods, and results was manually collected. Two UACR categorization approaches were defined: a two-category (UACR <10 mg/g vs. 10-30 mg/g) and a three-category division (UACR <5 mg/g vs. 5-10 and 10-30 mg/g). A random effects meta-analysis was performed on studies eligible for the meta-analysis.
RESULTS: In total, 22 manuscripts were identified for the systematic review, 15 of which were eligible for the meta-analysis. The results suggest an association between elevated UACR within the normal to mildly increased range and higher risks of all-cause mortality, cardiovascular death, and coronary heart disease, particularly in the range of 10-30 mg/g. Compared with UACR <10 mg/g, the hazard ratio [HR (95% confidence interval, CI)] for UACR between 10 and 30 mg/g was 1.41 (1.15, 1.74) for all-cause mortality and 1.56 (1.23, 1.98) for coronary heart disease. Compared with UACR <5 mg/g, the risk of cardiovascular mortality for UACR between 10 and 30 mg/g was more than twofold [HR (95% CI): 2.12 (1.61, 2.80)]. Intermediate UACR (5-10 mg/g) was also associated with a higher risk of all-cause mortality [HR (95% CI): 1.14 (1.05, 1.24)] and cardiovascular mortality [HR (95% CI): 1.50 (1.14, 1.99)].
CONCLUSIONS: We propose considering higher UACR within the normoalbuminuric range as a prognostic factor for cardiovascular morbidity and mortality. Our findings underscore the clinical significance of even mild increases in albuminuria.
摘要：
目的：评估正常范围内尿白蛋白-肌酐比值（UACR）类别与死亡率和不良心血管结局之间的关系。
方法：系统搜索PubMed和Embase的真实世界证据研究。根据预定的合格标准手动评估研究。我们纳入了UACR类别<30mg/g与心血管结局或死亡率之间相关性的前瞻性和回顾性队列研究。已发布有关研究设计的信息，参与者,UACR分类，统计方法，结果是手动收集的。定义了两种UACR分类方法：两类(UACR<10mg/g与10-30mg/g）和三类划分（UACR<5mg/gvs.5-10和10-30mg/g）。对符合荟萃分析条件的研究进行了随机效应荟萃分析。
结果：总计，为系统审查确定了22份手稿，其中15人符合荟萃分析的条件。结果表明，正常至轻度增加范围内的UACR升高与全因死亡率风险升高之间存在关联。心血管死亡,和冠心病，特别是在10-30mg/g的范围内。与UACR<10mg/g相比，危险比[HR(95%置信区间，CI）]对于10至30mg/g的UACR，全因死亡率为1.41（1.15，1.74），冠心病为1.56（1.23，1.98）。与UACR<5mg/g相比，UACR在10-30mg/g之间的心血管死亡风险超过2倍[HR(95%CI):2.12(1.61,2.80)].中间UACR（5-10mg/g）也与全因死亡率[HR（95％CI）：1.14（1.05，1.24）]和心血管死亡率[HR（95％CI）：1.50（1.14，1.99）]的高风险相关。
结论：我们建议考虑在正常白蛋白尿范围内更高的UACR作为心血管疾病发病率和死亡率的预后因素。我们的发现强调了蛋白尿甚至轻度增加的临床意义。
方法：系统搜索PubMed和Embase的真实世界证据研究。根据预定的合格标准手动评估研究。我们纳入了UACR类别<30mg/g与心血管结局或死亡率之间相关性的前瞻性和回顾性队列研究。已发布有关研究设计的信息，参与者,UACR分类，统计方法，结果是手动收集的。定义了两种UACR分类方法：两类(UACR<10mg/g与10-30mg/g）和三类划分（UACR<5mg/gvs.5-10和10-30mg/g）。对符合荟萃分析条件的研究进行了随机效应荟萃分析。
结果：总计，为系统审查确定了22份手稿，其中15人符合荟萃分析的条件。结果表明，正常至轻度增加范围内的UACR升高与全因死亡率风险升高之间存在关联。心血管死亡,和冠心病，特别是在10-30mg/g的范围内。与UACR<10mg/g相比，危险比[HR(95%置信区间，CI）]对于10至30mg/g的UACR，全因死亡率为1.41（1.15，1.74），冠心病为1.56（1.23，1.98）。与UACR<5mg/g相比，UACR在10-30mg/g之间的心血管死亡风险超过2倍[HR(95%CI):2.12(1.61,2.80)].中间UACR（5-10mg/g）也与全因死亡率[HR（95％CI）：1.14（1.05，1.24）]和心血管死亡率[HR（95％CI）：1.50（1.14，1.99）]的高风险相关。
结论：我们建议考虑在正常白蛋白尿范围内更高的UACR作为心血管疾病发病率和死亡率的预后因素。我们的发现强调了蛋白尿甚至轻度增加的临床意义。
