Elevated serum uric acid concentration at discharge confers additive prognostic value in elderly patients with acute heart failure

• Published in: Nutrition, metabolism, and cardiovascular diseases Vol. 28; no. 4; pp. 361 - 368
• Main Authors: Coiro, S., Carluccio, E., Biagioli, P., Alunni, G., Murrone, A., D'Antonio, A., Zuchi, C., Mengoni, A., Girerd, N., Borghi, C., Ambrosio, G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2018
• Subjects: Age Factors; Aged; Aged, 80 and over; Biomarkers - blood; Cause of Death; Decision Support Techniques; Disease Progression; Echocardiography; Elderly; Female; Heart failure; Heart Failure - blood; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - therapy; Humans; Hyperuricemia - blood; Hyperuricemia - diagnosis; Hyperuricemia - mortality; Male; Middle Aged; Outcome; Patient Discharge; Patient Readmission; Predictive Value of Tests; Progression-Free Survival; Retrospective Studies; Risk Factors; Time Factors; Up-Regulation; Uric acid; Uric Acid - blood; NRI; BNP; CRT-ICD; HHF; LVEF; HR; UA; ACE-i; BUN; BMI; Heart failure; eGFR; AF; JCARE-CARD; CI; SpO2; Uric acid; TAPSE; PAPs; ARB; Outcome; XO; Elderly; HF; sUA; COPD
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2017.12.009

Elevated serum uric acid (sUA) concentrations have been associated with worse prognosis in heart failure (HF) but little is known about elderly patients. We aimed to assess long-term additive prognostic value of sUA in elderly patients hospitalized for HF. Clinical and echocardiographic characteristics of 310 consecutive elderly patients hospitalized for HF were collected. During index period, 206 had sUA concentrations available, which were obtained within 24 h prior to discharge; 10 patients were lost to follow-up, leaving 196 patients available. Patients had a median age of 77 (IQR 69–83) years, and were mostly male (64.5%). sUA ranges for tertiles I–III were: 1.5–6.1, 6.2–8.3, and 8.4–18.9 mg/dl, respectively. During a median follow-up of 27 months (IQR 10.5–39.5), 122 combined events occurred (87 deaths and 73 HF rehospitalizations). Four-year event-free survival for the combined endpoint was 46 ± 7% for tertile I, 34 ± 7% for tertile II, and 21 ± 5% for tertile III (P = 0.001). By multivariable Cox backward analysis, sUA was retained as a significant predictor. Compared with the lowest sUA tertile, tertile III showed a strong association with outcome, also after adjustment for other predictors (HR 1.84, 95% CI 1.16–2.93; P = 0.01). Importantly, addition of sUA to the other significant predictors of outcome resulted in improved risk classification (net reclassification improvement 0.19, P = 0.017). High sUA at discharge is a strong predictor of adverse outcome in elderly hospitalized for HF, and it significantly improves risk classification. Measuring sUA can be a simple and useful tool to identify high-risk elderly hospitalized for HF.