IMPACT OF PROTEINURIA ON LONG-TERM MORTALITY IN PATIENTS WITH HYPERTENSIVE CRISIS VISITING THE EMERGENCY DEPARTMENT

초록

OBJECTIVE: Hypertensive crisis is associated with poor clinical outcomes. Proteinuria, frequently observed in hypertensive crisis, is a risk factor for cardiovascular and all-cause mortality in patients with hypertension. However, in patients presenting with hypertensive crisis and proteinuria, the impact of proteinuria on long-term mortality are unknown. We investigated the association of proteinuria with all-cause mortality. DESIGN AND METHOD: This retrospective study at a tertiary referral center conducted with adult patients who were admitted to the ED between 2016 and 2019 with hypertensive crisis, which was defined as systolic blood pressure > = 180 mmHg and/or diastolic blood pressure > = 100 mmHg. Of 10,219 patients with hypertensive crisis, 5,421 patients with an assay for proteinuria were enrolled in this study. Proteinuria was defined as a trace or more of protein on a urine dipstick test performed at ED. RESULTS: Proteinuria was present in 2,855 (52.7%) of the 5,421 patients. At 3 years, crude all-cause mortality rates were 9.6% for patients who were negative proteinuria, 17.9% for those with trace proteinuria, 25.7% for those with proteinuria (1+), 28.9% for those with proteinuria (2+), 33.6% for those with proteinuria (> = 3+). After adjusting for sex, age, blood pressure, and comorbid condition, the hazard ratio (95% CI) for dipstick proteinuria was 1.74 (1.44-2.10) for those with trace proteinuria, 2.24 (1.84-2.72) for those with proteinuria (1+), 2.21 (1.76-2.78) for those with proteinuria (2+), 2.30 (1.75-3.01) for those with proteinuria (> = 3+) compared with the reference of negative proteinuria. CONCLUSIONS: Proteinuria, which was detected on a urine dipstick test, was a significant predictor of all-cause mortality in patients with hypertensive crisis.