title: Prognostic significance of serum uric acid in outpatients with chronic heart failure is complex and related to body mass index: data from the IN-CHF Registry.
abstract: OBJECTIVE
  In the field of cardiovascular diseases, elevated levels of serum uric acid (UA) reflect a marked activation of the xanthine oxidase pathway with increase in free radicals production; it is often associated with an inflammatory state, oxygen consumption and endothelial dysfunction. All these associations have been also confirmed in heart failure (HF) but the pathophysiological role of UA in this setting is not well understood. The aim of this study was to evaluate the prognostic role of UA in outpatients enrolled in the Italian Registry of Congestive Heart Failure (IN-CHF).
  
  
  RESULTS
  All patients met the European Society of Cardiology (ESC) criteria for diagnosis of HF. We considered patients with complete clinical data and UA level available at the baseline and at 1-year follow-up. The study population was composed of 877 patients aged 63 ± 12 years. One-year mortality was 10.8% and dead patients had a higher level of UA than survivors (7.1 mg dl⁻¹ vs 6.6 mg dl⁻¹, p < 0.0207). In multivariable full model of analysis, UA did not result in an independent predictor of death in overall population, but only in patients with low body mass index (BMI) (≤22 kg m⁻²) (hazard ratio (HR): 2.38, 95% confidence interval (CI) 1.36-4.18). In this subgroup, a statistically significant gradual relationship between UA and survival was detected starting from values higher than 8 mg dl⁻¹.
  
  
  CONCLUSIONS
  Elevated level of UA is not an independent predictor of mortality in chronic HF, but it markedly worsens outcome if associated with low level of BMI. This association is likely an indicator of chronic inflammatory and catabolic state.
authors.affiliation: Department of Heart and Vessel, Section Internal Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Baldasseroni
authors.forename: R
authors.initials: R
authors.lastname: Urso
authors.forename: A P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: F
authors.initials: F
authors.lastname: Orso
authors.forename: G
authors.initials: G
authors.lastname: Fabbri
authors.forename: N
authors.initials: N
authors.lastname: Marchionni
authors.forename: L
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015992:Body Mass Index; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D033461:Hyperuricemia / Q000150:complications* / Q000209:etiology* / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009026:Mortality; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013851:Thinness / Q000150:complications*; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid