Prognostic significance of dipstick proteinuria in heart failure with preserved ejection fraction: insight from the PURSUIT-HFpEF registry.
OBJECTIVE
The semiquantitative urine dipstick test is a simple and convenient method that is available in the smallest community-based healthcare clinics. We sought to clarify the prognostic significance of dipstick proteinuria in patients with heart failure (HF) with preserved ejection fraction (HFpEF).


DESIGN
A Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction (PURSUIT-HFpEF) registry.


PARTICIPANTS AND SETTING
We assessed 851 discharged-alive patients in the PURSUIT-HFpEF registry who were initially hospitalised due to an acute decompensated HFpEF (EF≥50%) and elevated N-terminal-pro-brain natriuretic peptide (≥400 ng/L) at Osaka University Hospital and other 30 affiliated hospitals in the Kansai region of Japan. Patients received a urine dipstick test, and were divided into two groups according to the absence or presence of proteinuria. A trace or more of dipstick proteinuria was defined as the presence of proteinuria.


MAIN OUTCOME MEASURES
A composite of cardiac death or HF rehospitalisation.


RESULTS
Median age was 83 years and 473 patients (55.6%) were female. Five hundred and two patients (59%) were proteinuria (-) and 349 patients (41%) were proteinuria (+). The composite endpoint and HF rehospitalisation occurred more often in proteinuria (+) individuals than proteinuria (-) individuals (log-rank p=0.006 and p=0.007, respectively); but cardiac death did not (log-rank p=0.139). Multivariable Cox regression analysis showed that the presence of proteinuria was associated with the composite endpoint (HR: 1.47, 95% CI 1.07 to 2.01, p=0.016), and HF rehospitalisation (HR: 1.48, 95% CI 1.07 to 2.05, p=0.020), but not with cardiac death (HR: 1.52, 95% CI 0.83 to 2.76, p=0.172).


CONCLUSIONS
Dipstick proteinuria may be a prognostic marker in patients with HFpEF. Evaluation of proteinuria by a urine dipstick test may be a simple but useful method for risk stratification in HFpEF.


UMIN-CTR ID
UMIN000021831.
['Oeun|Bolrathanak|B|', 'Hikoso|Shungo|S|0000-0003-2284-1970', 'Nakatani|Daisaku|D|', 'Mizuno|Hiroya|H|', 'Suna|Shinichiro|S|', 'Kitamura|Tetsuhisa|T|', 'Okada|Katsuki|K|', 'Dohi|Tomoharu|T|', 'Sotomi|Yohei|Y|0000-0002-7564-2978', 'Kida|Hirota|H|', 'Sunaga|Akihiro|A|', 'Sato|Taiki|T|', 'Nakagawa|Akito|A|', 'Nakagawa|Yusuke|Y|', 'Hayashi|Takaharu|T|', 'Yano|Masamichi|M|', 'Tamaki|Shunsuke|S|', 'Yasumura|Yoshio|Y|', 'Yamada|Takahisa|T|', 'Sakata|Yasushi|Y|0000-0002-5618-4721', '|||']
D000369:Aged, 80 and over D005260:Female D006333:Heart Failure D006801:Humans D011379:Prognosis D011446:Prospective Studies D011507:Proteinuria D012042:Registries D013318:Stroke Volume D016277:Ventricular Function, Left
heart failure adult cardiology internal medicine