title: Orosomucoid in urine is a powerful predictor of cardiovascular mortality in normoalbuminuric patients with type 2 diabetes at five years of follow-up.
abstract: OBJECTIVE
  To study whether urinary orosomucoid excretion rate (UOER) predicts mortality in normoalbuminuric patients with diabetes at 5 years of follow-up, and to investigate the relationship between orosomucoid in serum and urine.
  
  
  METHODS
  A cohort of 578 patients with diabetes (430 type 2, 148 type 1) was followed prospectively for an average of 5 years. UOER was measured in timed overnight urine samples.
  
  
  RESULTS
  Eighty-two patients with type 2 diabetes and 17 patients with type 1 diabetes died. Among patients with type 2 diabetes, 251 (58%) had normoalbuminuria; increased UOER independently predicted cardiovascular mortality (OR 4.94, 95% CI 1.60-15.22; p<0.006) in those with normoalbuminuria and in the entire cohort of patients with type 2 diabetes (odds ratio 3.63, 95% CI 1.50-8.81; p<0.005). Patients with increased UOER had a higher all-cause mortality than those with normal UOER (log-rank test, p<0.001 for type 2 patients; p<0.04 for type 1 patients). In patients with type 1 diabetes, there were five cardiovascular deaths and no significant predictive value of UOER. Patients with increased UOER had a subclinical increase in serum orosomucoid.
  
  
  CONCLUSIONS
  Increased UOER was an independent, powerful predictor of cardiovascular mortality in normoalbuminuric patients with type 2 diabetes and in the entire cohort of patients with type 2 diabetes. There were indications of UOER as being a valuable marker in type 1 diabetes that showed differences in survival between patients with normal versus increased UOER. Serum orosomucoid was associated with UOER; UOER may be a marker of low-grade inflammation in patients with diabetes.
authors.affiliation: Department of Clinical Biochemistry, Amager Hospital, Italiensvej 1, 2300 Copenhagen, Denmark. skovdal@dadlnet.dk
authors.forename: M S
authors.initials: MS
authors.lastname: Christiansen
authors.forename: E
authors.initials: E
authors.lastname: Hommel
authors.forename: E
authors.initials: E
authors.lastname: Magid
authors.forename: B
authors.initials: B
authors.lastname: Feldt-Rasmussen
mesh_terms: D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009961:Orosomucoid / Q000652:urine*; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine; D006442:Glycated Hemoglobin; D009961:Orosomucoid