Urine albumin-creatinine ratio a marker of adverse outcomes in diabetic foot osteomyelitis

Among patients with diabetic foot osteomyelitis (DFO), elevated urine albumin-creatinine ratio levels are associated with increased risks of all-cause mortality, major cardiovascular adverse events (MACE), and mixed endpoint events, a study reports.

The study included 202 hospitalized patients with DFO (mean age 60.3 years, 62.9 percent male, 45.05 percent urinary protein-positive). Based on their urine albumin-creatinine ratio (UACR), 11 patients (54.95 percent) had normoalbuminuria, 50 (24.75 percent) had microalbuminuria, and 41 (20.30 percent) had macroalbuminuria.

Most clinical data were similar across the three patient groups, except for serum creatinine, rate of coronary heart disease, hindfoot infection, and severe infection, all of which were higher in the microalbuminuria or macroalbuminuria groups as opposed to the normoalbuminuria group.

The incidence rates of all-cause mortality, MACE, and mixed endpoint events were higher among DFO patients who had elevated UACR (p_trend<0.01 for all). The risks of these outcomes relative to the normoalbuminaria group were higher by 81.8 percent, 135.4 percent, and 136.4 percent, respectively, in the microalbuminuria group; and by 246.2 percent, 145.1 percent, and 252.3 percent, respectively, in the macroalbuminuria group.

On a population attributable risk percentage analysis, elevated UACR accounted for 50.16 percent of all-cause mortality, 47.85 percent of MACE, and 59.11 percent of the mixed endpoint events.