title: Does Uric Acid Level Provide Additional Risk Stratification Information in Emergency Patients With Symptoms of Possible Acute Coronary Syndrome?
abstract: Elevated uric acid levels have been associated with the presence and severity of coronary artery disease (CAD). This study aimed to assess the clinical utility of serum uric acid levels to identify patients at high risk of acute coronary syndrome (ACS) in those who presented to the emergency department (ED) with chest pain.
  
  
  
  This was a prospective observational study of 951 adult patients who were being evaluated for ACS in a single ED. Serum uric acid was taken on presentation. Patients were followed up 30 days and 1 year after initial presentation. The primary outcome was a diagnosis of ACS within 30 days of initial attendance. A logistic regression analysis was performed to identify whether elevated uric acid levels were predictive of ACS. Kaplan-Meier curves were generated to identify 1-year mortality in those who were available for 1-year follow-up and Cox regression was performed to identify whether uric acid levels were an independent predictor of mortality.
  
  
  
  ACS was diagnosed in 88 patients and 140 patients had elevated uric acid levels. A total of 679 patients agreed to 1-year follow-up. Elevated uric acid levels were not associated with a diagnosis of ACS (p = 0.96). Patients with elevated uric acid had a higher 1-year death rate (8/101; 7.92%) compared with patients with normal uric acid levels (12/596; 2.01%, p < 0.01).
  
  
  
  Uric acid levels lack diagnostic utility for ACS but may be useful for identifying ED patients with chest pain who are at high risk for 1-year mortality. Elevated uric acid levels correlate with the presence of other risk factors of CAD and are a marker for poor long-term outcome.
authors.affiliation: From the *School of Medicine, The University of Queensland, St Lucia, QLD, Australia; †Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; ‡School of Public Health, Queensland University of Technology, Brisbane, QLD, Australia; §Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; ¶Emergency Department, Christchurch Hospital, Christchurch, New Zealand; and ‖Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Harry
authors.initials: H
authors.lastname: Jin
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
authors.forename: Tracey
authors.initials: T
authors.lastname: Hawkins
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid