血清尿酸水平升高对慢性心力衰竭患者长期预后的影响：GISSI-HF（意大利心力衰竭生存研究组）试验的事后分析。
Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic heart failure: A post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial.
机构信息
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy.
出版信息
Metabolism. 2018 Jun;83:205-215. doi: 10.1016/j.metabol.2018.02.007. Epub 2018 Mar 29.
BACKGROUND
The prognostic impact of hyperuricemia on long-term clinical outcomes in patients with chronic heart failure (HF) has been investigated in observational registries and clinical trials, but the results have been often inconclusive. We examined the prognostic impact of elevated serum uric acid levels on long-term clinical outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial.
CLINICAL TRIAL REGISTRATION
CLINICALTRIALS.
GOV IDENTIFIER
NCT00336336.
METHODS
We assessed the rates of all-cause death, cardiovascular death, cardiovascular hospitalization and the composite of all-cause death or cardiovascular hospitalization over a median follow-up of 3.9 years among 6683 ambulatory patients with chronic HF.
RESULTS
Patients in the 3rd serum uric acid tertile (>7.2 mg/dl) had a nearly 1.8-fold increased risk of both all-cause death and cardiovascular death, and a nearly 1.5-fold increased risk of cardiovascular hospitalization and of the composite endpoint compared to those in the 1st uric acid tertile (<5.7 mg/dl). Beyond serum uric acid ≥ 7 mg/dl the risk of outcomes increased sharply and linearly. The significant association between elevated serum uric acid levels and adverse outcomes persisted after adjustment for multiple established cardiovascular risk factors, HF etiology, left ventricular ejection fraction, medication use and other potential confounders, with an adjusted hazard ratio of 1.37 (95% CI 1.22-1.55) for all-cause death, 1.48 (1.29-1.69) for cardiovascular death, 1.19 (1.09-1.30) for cardiovascular hospitalization and 1.21 (1.11-1.31) for the composite endpoint, respectively.
CONCLUSIONS
Elevated serum uric acid levels are independently associated with poor long-term survival and increased risk of cardiovascular hospitalization in patients with chronic HF.
背景
在观察性登记和临床试验中已经研究了高尿酸血症对慢性心力衰竭（HF）患者长期临床结局的预后影响，但结果往往不一致。我们研究了血清尿酸水平升高对 GISSI-HF（意大利心力衰竭生存研究组）试验中慢性 HF 患者长期临床结局的预后影响。
临床试验注册
CLINICALTRIALS.GOV IDENTIFIER：NCT00336336。
方法
我们评估了 6683 例慢性 HF 门诊患者中位随访 3.9 年期间全因死亡、心血管死亡、心血管住院和全因死亡或心血管住院复合终点的发生率。
结果
第 3 个血清尿酸三分位数（>7.2mg/dl）的患者全因死亡和心血管死亡的风险增加近 1.8 倍，心血管住院和复合终点的风险增加近 1.5 倍，与第 1 个尿酸三分位数（<5.7mg/dl）相比。血清尿酸≥7mg/dl 后，结局风险急剧且呈线性增加。在调整多个已建立的心血管危险因素、HF 病因、左心室射血分数、药物使用和其他潜在混杂因素后，升高的血清尿酸水平与不良结局之间的显著关联仍然存在，全因死亡的调整后的危险比为 1.37（95%CI 1.22-1.55），心血管死亡为 1.48（1.29-1.69），心血管住院为 1.19（1.09-1.30），复合终点为 1.21（1.11-1.31）。
结论
升高的血清尿酸水平与慢性 HF 患者的长期生存不良和心血管住院风险增加独立相关。
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