Coiro S, Carluccio E, Biagioli P, Alunni G, Murrone A, D'Antonio A, Zuchi C, Mengoni A, Girerd N, Borghi C, Ambrosio G
Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France.
Nutr Metab Cardiovasc Dis. 2018 Apr;28(4):361-368. doi: 10.1016/j.numecd.2017.12.009. Epub 2018 Jan 10.
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.
血清尿酸（sUA）浓度升高与心力衰竭（HF）患者预后较差有关，但老年患者的相关情况知之甚少。我们旨在评估sUA对因HF住院老年患者的长期附加预后价值。
收集了310例因HF连续住院的老年患者的临床和超声心动图特征。在索引期内，206例患者有sUA浓度数据，这些数据在出院前24小时内获得；10例患者失访，剩余196例患者可供分析。患者的中位年龄为77岁（四分位间距69 - 83岁），男性居多（64.5%）。sUA三分位数I - III的范围分别为：1.5 - 6.1、6.2 - 8.3和8.4 - 18.9mg/dl。在中位随访27个月（四分位间距10.5 - 39.5个月）期间，发生了122例联合事件（87例死亡和73例HF再住院）。联合终点的4年无事件生存率在三分位数I为46±7%，三分位数II为34±7%，三分位数III为21±5%（P = 0.001）。通过多变量Cox向后分析，sUA被保留为显著预测因子。与最低sUA三分位数相比，三分位数III与结局有很强的关联，在调整其他预测因子后也是如此（风险比1.84，95%置信区间1.16 - 2.93；P = 0.01）。重要的是，将sUA添加到其他显著的结局预测因子中可改善风险分类（净重新分类改善0.19，P = 0.017）。
出院时高sUA是因HF住院老年患者不良结局的强预测因子，且能显著改善风险分类。检测sUA可为识别因HF住院的高危老年患者提供一种简单且有用的工具。
