P3436The J-curve relationship between admission glucose level and 1-year mortality in patients with acute heart failure: results from an international observational cohort

Purpose: This study sought to investigate whether renal tubulointerstitial damage assessed by urinary N-acetyl--D-glucosamidase (UNAG), a marker of early renal tubulointerstitial damage, on admission could be a determinant of subsequent risk of adverse events in patients with acute heart failure. Methods and results: UNAG was measured on admission in consecutive 710 prospectively registered acute heart failure patients between January 2013 and May 2016. Patients were stratified into tertiles according to UNAG levels. Patients with higher UNAG had higher heart rate (P<0.001) and lower serum sodium level (P=0.022) compared to those with lower UNAG, but age, systolic blood pressure, B-type natriuretic peptide level and renal function related parameters were comparable across tertiles. Furthermore, patients with higher UNAG had significantly lower net fluid loss (P<0.001) and estimated plasma volume reduction rate (P=0.003) for first 48 hours, and higher incidence of subsequent worsening renal function (P=0.023) and lower estimated plasma volume reduction rate (P=0.003) during hospitalization than those with lower UNAG. During a median follow-up period of 763 (interquartile range 434-1029) days, higher UNAG was significantly associated with increased events of all-cause death and worsening heart failure (Figure In addition, patients with higher UNAG creatinine ratio (11 U/g, the median) and lower estimated glomerular filtration rate (<45 mL/min/1.73m 2 , the median) on admission had the worst clinical outcomes among four groups (Figure In multivariable Cox regressions, UNAG creatinine ratio on admission remained an independent determinant of long-term adverse events (hazard ratio [HR] 1.29, 95% confidential interval [CI] 1.09-1.52) even after adjustment by 12 predetermined covariates predominantly including prior heart failure hospitalization, age, hemoglobin, systolic blood pressure, blood urea nitrogen, high sensitive troponin T and serum sodium levels, while urinary 2-microglobulin creatinine ratio was not significant determinant (HR 0.98, 95% CI 0.91-1.05).