The prognostic impact of uric acid in patients with severely decompensated acute heart failure

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• 作者：Hirotake Okazaki ; MD ; PhD^a ; Akihiro Shirakabe ; MD ; PhD^a ; ^{s6042@nms.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Nobuaki Kobayashi ; MD ; PhD^a ; Noritake Hata ; MD ; PhD^a ; Takuro Shinada ; MD ; PhD^a ; Masato Matsushita ; MD^a ; Yoshiya Yamamoto ; MD^a ; Junsuke Shibuya ; MD^a ; Reiko Shiomura ; MD^a ; Suguru Nishigoori ; MD^a ; Kuniya Asai ; MD ; PhD^b ; Wataru Shimizu ; MD ; PhD ; FJCC^b
• 关键词：Uric acid ; Renal failure ; Loop diuretics ; Acute heart failure syndrome
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：68
• 期：5
• 页码：384-391
• 全文大小：536 K

文摘

The serum level of uric acid (UA) is a well-known prognostic factor for heart failure (HF) patients. However, the prognostic impact of hyperuricemia and the factors that induce hyperuricemia in acute HF (AHF) patients are not well understood.

Methods and results

Eight hundred eighty-nine AHF patients were enrolled in this study. The patients were assigned into a low UA group (UA ≤ 7.0 mg/dl, n = 495) or a high UA group (UA > 7.0 mg/dl, n = 394) according to their UA level on admission. A Kaplan–Meier curve showed that the survival rate of the low UA group was significantly higher than that of the high UA group. A multivariate Cox regression model identified that a high UA level (HR: 1.192, 95%CI 1.112–1.277) was an independent predictor of 180-day mortality. A multivariate logistic regression model for a high serum UA level on admission indicated that chronic kidney disease (CKD) (OR: 2.030, 95%CI: 1.298–3.176, p = 0.002) and the administration of loop diuretics before admission (OR: 1.556, 95%CI: 1.010–2.397, p = 0.045) were independent factors. The prognosis, including all-cause death and HF events, was significantly poorer among patients who had a high UA level who had previously used loop diuretics and among CKD patients with a high UA level than among other patients.

Conclusions

The serum UA level was an independent predictor in patients who were hospitalized during an emergent situation for AHF. An elevated serum UA level on admission was associated with the presence of CKD and the use of loop diuretics. These factors were also associated with adverse outcomes in hyperuricemic patients with AHF.