In-Hospital Serum Uric Acid Change Predicts Adverse Outcome in Patients With Heart Failure

• Published in: Journal of cardiac failure Vol. 26; no. 11; pp. 968 - 976
• Main Authors: Yamamoto, HIRONORI, NAGATOMO, YUJI, MAHARA, KEITARO, YOSHIKAWA, TSUTOMU
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020
• Subjects: heart failure; Uric acid; heart failure; Uric acid
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2020.07.002

•Uric acid (UA) level fluctuates during the treatment of acute decompensated heart failure.•UA change during acute decompensated heart failure treatment was correlated with age, estimated glomerular filtration rate, left ventricular ejection fraction, and loop diuretic dose.•UA change during acute decompensated heart failure treatment independently predicted adverse clinical outcome.•The prognostic impact of UA change was significant in heart failure with reduced ejection fraction, but not in heart failure with midrange ejection fraction or heart failure with preserved ejection fraction. Elevated serum uric acid (UA) is associated with an increased risk of adverse outcome in patients with heart failure (HF), but it remains unknown whether the change of serum UA level during the treatment of acute decompensated HF (ADHF) predicts adverse events. We retrospectively analyzed consecutive 1562 patients who were hospitalized for ADHF. Serum UA levels both at admission and discharge were available in 1246 patients (78 years of age, range 69–84 years, 40% female). UA values increased or unchanged (group I) in 766 patients and it decreased in the remaining patients (group D). Group I was characterized by older age, higher proportion of females, preserved left ventricular ejection fraction, and the features of less severity of HF such as lower plasma N-terminal pro B-type natriuretic peptide level and lower percentage of catecholamine use. Nevertheless, group I was associated with higher incidence of the primary end point defined as the composite of all-cause death and ADHF rehospitalization (P = .013, log-rank test). UA change, but not UA at discharge, was an independent predictor of the primary end point (hazard ratio 1.30, interquartile range 1.04–1.64, P = .022). Age, estimated glomerular filtration rate, left ventricular ejection fraction, dose of loop diuretics, and thiazide prescription at discharge were independently associated with the UA change. In patients with HF, UA change through the treatment of ADHF might predict future adverse outcome.