title: Prognostic Significance of Hyperuricemia in Patients With Acute Heart Failure.
abstract: Serum uric acid (UA) is associated with death and hospitalization in chronic heart failure (HF). However, UA in acute HF has not been well studied with respect to its relation to renal dysfunction and vascular congestion. We measured admission serum UA along with baseline variables in 281 patients with acute HF screened from the Loop Diuretics Administration and Acute Heart Failure (Diur-HF) trial. Hyperuricemia was defined as serum UA >7 mg/dl in men and >6 mg/dl in women. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m(2) before hospital admission. Death or HF hospitalization at 6 months was the primary outcome. The mean UA concentration was 6.4 ± 2.5 mg/dl, and 121 patients (43.1%) were classified as hyperuricemic. UA values were significantly increased in patients with CKD compared to patients without CKD (6.8 ± 2.7 vs 6.1 ± 2.1 mg/dl; p = 0.02); however, UA was not associated with the development of acute kidney injury. Patients with hyperuricemia had greater degrees of pulmonary and systemic congestion than normouricemic patients (congestion score 3.5 vs 2.1, p <0.01). Hyperuricemia was associated with higher risk of death or HF rehospitalization (univariate hazard ratio 1.46 [1.02 to 2.10]; p = 0.04, multivariate hazard ratio 1.69 [1.16 to 2.45]; p = 0.005). In conclusion, hospitalized patients with acute HF, elevated UA levels were associated with both CKD and pulmonary congestion. After controlling for potential confounders, hyperuricemia was associated with rehospitalization and death at 6 months.
authors.affiliation: Department of Internal Medicine, Cardiology Unit, University of Siena, Siena, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.affiliation: Department of Internal Medicine, Cardiology Unit, University of Siena, Siena, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ruocco
authors.affiliation: Department of Internal Medicine, Cardiology Unit, University of Siena, Siena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrini
authors.affiliation: Department of Internal Medicine, Cardiology Unit, University of Siena, Siena, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Beltrami
authors.affiliation: Department of Internal Medicine, Cardiology Unit, University of Siena, Siena, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Giordano
authors.affiliation: Department of Internal Medicine, Cardiology Unit, University of Siena, Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.affiliation: Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor Heart and Vascular Institute, Dallas, Texas; The Heart Hospital Baylor, Plano, Texas. Electronic address: peteramccullough@gmail.com.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000453:epidemiology*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D049994:Sodium Potassium Chloride Symporter Inhibitors; D014527:Uric Acid