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Association of urinary albumin-to-creatinine ratio with all-cause and cardiovascular disease mortality risk in patients with osteoarthritis: a prospective cohort study
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DOI：10.1007/s10067-026-08343-0.png)
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Abstract
En 中文
Osteoarthritis (OA) is associated with increased all-cause and cardiovascular disease (CVD) mortality, yet simple biomarkers for risk stratification are lacking. UACR, which measures the albumin-to-creatinine ratio in urine, is a known marker for kidney injury and mortality prediction in different populations, but its prognostic value in OA remains unknown. This prospective cohort study included 3061 US adults with OA from the National Health and Nutrition Examination Survey 2005–2018. Weighted Cox proportional hazards models, Kaplan–Meier curves, subgroup analyses, and multiple imputation sensitivity analyses were performed. During a median follow-up period of 81.3 months, there were 526 deaths from all causes and 147 deaths from CVD disease. Higher UACR was associated with stepwise increased mortality (log-rank P < 0.001). For every 100 mg/g rise in UACR, the fully adjusted models showed HRs of 1.04 (95% CI 1.03–1.06) for mortality from all causes and 1.04 (1.00–1.07) for mortality due to CVD. When compared to a UACR of less than 30 mg/g, the HRs for UACR levels between 30–300 mg/g and 300 mg/g or more were 2.01 (1.54–2.63) and 4.29 (2.66–6.93) for all-cause mortality and 2.28 (1.48–3.51) and 3.84 (1.87–7.90) for CVD mortality (both P for trend < 0.001). Stronger associations were noted among females and those with lung disease (P for interaction = 0.030 and < 0.001, respectively). Sensitivity analyses confirmed robustness. Elevated UACR is independently and incrementally associated with higher all-cause and CVD mortality in OA patients, especially in women and those with comorbid lung disease. UACR may function as an uncomplicated, non-invasive tool for predicting risk in OA.
Keywords:
Osteoarthritis
Urinary albumin-to-creatinine ratio
Sex difference
Lung disease
Mortality
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