Uric acid, allopurinol therapy, and mortality in patients with acute heart failure--results of the Acute HEart FAilure Database registry.
OBJECTIVE
The aim of this study was to explore the prognostic role of serum uric acid (UA) measurement in the hospital and long-term mortality assessment in subjects with acute heart failure (AHF) from the Acute HEart FAilure Database registry (AHEAD). The AHEAD registry comprised 4153 patients with AHF syndromes hospitalized at the AHEAD participating centers.


METHODS
The study included 1255 patients who were admitted to the AHEAD participating centers with acute decompensated chronic heart failure, de novo heart failure, or cardiogenic shock between September 2006 and October 2009 and who had information about serum UA concentration available at the time of hospital admission. The hospital and long-term mortality was followed using the centralized database of the Ministry of Health, Czech Republic. The mean age of the cohort was 73.4 years, the female population represented 43%, the median hospital stay was 8 days, and the mean hospital mortality was 7.6%.


RESULTS
The median UA concentration of the patients with AHF was 432 μmol/L (7.26 mg/dL), the median estimated glomerular filtration rate (eGFR) was 49.0 mL/min, and N-terminal pro-brain natriuretic peptide level was 5510 pg/mL. Among other laboratory variables, UA concentration greater than 515 μmol/L (8.67 mg/dL) was associated with increased hospital mortality (P < .001), as well as eGFR less than 30 mL/min (P < .001), Na 135 mmol/L or less, and positive troponin. Uric acid concentration greater than 500 μmol/L (8.41 mg/dL) was associated with increased long-term mortality (P < .001), followed by eGFR less than 30 mL/min (P < .001), Na 135 mmol/L or less, and hemoglobin level lower than 130 g/L (P < .001). The 1-year survival rate of patients discharged from hospital (n = 1159) was 75.6%, and the 2-year rate was 66.8%. Survival of patients treated with allopurinol for hyperuricemia was significantly lower compared with untreated subjects (70.1 vs 77.2 for 1-year survival and 60.3 vs 68.5 for 2-year survival).


CONCLUSIONS
In patients with AHF, increased UA levels and documented allopurinol therapy for hyperuricemia were associated with increased hospital and long-term mortality. Allopurinol therapy is not a cause but the identifier of the subjects at risk.
Department of Cardiology, Na Homolce Hospital, Roentgenova 2, 150 30 Prague, Czech Republic. filip.malek@centrum.cz
Filip
F
Málek
Petr
P
Ošťádal
Jiří
J
Pařenica
Jiří
J
Jarkovský
Jiří
J
Vítovec
Petr
P
Widimský
Aleš
A
Linhart
Marián
M
Fedorco
Zdeněk
Z
Coufal
Roman
R
Miklík
Andreas
A
Krűger
Dagmar
D
Vondraková
Jindřich
J
Špinar
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006074:Gout Suppressants / Q000627:therapeutic use*; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D033461:Hyperuricemia / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D012737:Sex Factors; D014527:Uric Acid / Q000097:blood*
D006074:Gout Suppressants; D020097:Natriuretic Peptide, Brain; D014527:Uric Acid; D000493:Allopurinol