Background 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. Methods 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. Results 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. Conclusions 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. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • First nationally representative cohort study linking UACR with mortality in osteoarthritis patients. • Elevated UACR independently predicted higher all-cause and cardiovascular mortality in a dose–response manner. • Stronger associations were found in females and those with comorbid lung disease. • UACR may serve as a simple, non-invasive tool for mortality risk stratification in osteoarthritis. </entry> </row> </tbody> </tgroup> </Table>

Association of urinary albumin-to-creatinine ratio with all-cause and cardiovascular disease mortality risk in patients with osteoarthritis: a prospective cohort study

期刊论文
发表日期：

2026年8月4日

查看全文

He Chen,
Jun Ying,
Xianjie Xie,
Boyun Huang,
Pengcheng Lin

摘要

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Key Points

• First nationally representative cohort study linking UACR with mortality in osteoarthritis patients.

• Elevated UACR independently predicted higher all-cause and cardiovascular mortality in a dose–response manner.

• Stronger associations were found in females and those with comorbid lung disease.

• UACR may serve as a simple, non-invasive tool for mortality risk stratification in osteoarthritis.