Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan; Department of Cardiovascular Medicine, Osaka University, Suita, Japan.
Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan; Department of Cardiology, National Defense Medical College, Tokorozawa, Japan.
J Card Fail. 2020 Nov;26(11):968-976. doi: 10.1016/j.cardfail.2020.07.002. Epub 2020 Jul 9.
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.
血清尿酸（UA）升高与心力衰竭（HF）患者不良结局的风险增加相关，但血清 UA 水平在急性失代偿性 HF（ADHF）治疗过程中的变化是否预测不良事件尚不清楚。
我们回顾性分析了连续 1562 例因 ADHF 住院的患者。1246 例患者（78 岁，年龄范围 69-84 岁，40%为女性）入院时和出院时均可获得血清 UA 水平。UA 值升高或不变（I 组）的患者有 766 例，其余患者（D 组）UA 值降低。I 组的特点是年龄较大、女性比例较高、左心室射血分数保留以及 HF 严重程度较低，如血浆 N 末端 pro B 型利钠肽水平较低和儿茶酚胺使用比例较低。然而，I 组与主要终点（全因死亡和 ADHF 再住院的复合终点）的发生率较高相关（P=0.013，对数秩检验）。UA 变化而非出院时的 UA 是主要终点的独立预测因素（危险比 1.30，四分位距 1.04-1.64，P=0.022）。年龄、估计肾小球滤过率、左心室射血分数、出院时袢利尿剂剂量和噻嗪类药物处方与 UA 变化独立相关。
在 HF 患者中，ADHF 治疗过程中的 UA 变化可能预测未来的不良结局。
