Department of Cardiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China.
Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
Open Heart. 2024 Oct 31;11(2):e002830. doi: 10.1136/openhrt-2024-002830.
Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Serum uric acid (SUA), a product of purine metabolism, has been implicated in HF progression. However, the association between hyperuricaemia and the short-term readmission and mortality in patients with HF remains controversial.
In this retrospective cohort study, we analysed data from a HF database specific to the Chinese population. The primary endpoint was short-term readmission or all-cause mortality within 90 days. Participants with HF were categorised into normouricaemia group (NUA) and hyperuricaemia group (HUA) based on a SUA threshold of 420 µmol/L. The association between SUA and primary endpoint was evaluated using Kaplan-Meier survival curves and Cox regression analysis.
Baseline characteristics revealed significant differences between NUA and HUA groups, with the latter exhibiting a higher prevalence of males, chronic kidney disease (CKD) and elevated levels of various biomarkers. During a 90-day follow-up, 493 (26.6%) participants reached the primary endpoint, with a higher incidence observed in the HUA group at 31.2%, compared with 20.1% in the NUA group. When a threshold effect was identified at 420 µmol/L, a non-linear association was observed between SUA and the primary endpoint. After adjusting for gender, age, New York Heart Association class, CKD, systolic blood pressure (SBP) and potassium, the HUA group exhibited a higher risk for the primary endpoint compared with the NUA group (HR: 1.40, 95% CI: 1.14 to 1.72, p=0.001). Additionally, the risk increased across quartiles of SUA (P for trend=0.002). Furthermore, stratified analyses indicated a stronger association in patients without CKD (P interaction=0.033).
Hyperuricaemia is independently associated with an increased risk of short-term readmission and mortality in patients with HF. Our findings suggest that monitoring and managing SUA could be crucial in improving patient with HF outcomes.
心力衰竭（HF）是全球发病率和死亡率的主要原因。血清尿酸（SUA）是嘌呤代谢的产物，与 HF 的进展有关。然而，高尿酸血症与 HF 患者短期再入院和死亡率之间的关系仍存在争议。
在这项回顾性队列研究中，我们分析了特定于中国人群的 HF 数据库中的数据。主要终点是 90 天内的短期再入院或全因死亡率。根据 SUA 阈值 420μmol/L，将 HF 患者分为正常尿酸组（NUA）和高尿酸血症组（HUA）。使用 Kaplan-Meier 生存曲线和 Cox 回归分析评估 SUA 与主要终点之间的关系。
基线特征显示 NUA 和 HUA 组之间存在显著差异，后者男性、慢性肾脏病（CKD）和各种生物标志物水平升高的患病率较高。在 90 天的随访期间，493 名（26.6%）参与者达到了主要终点，HUA 组的发生率为 31.2%，高于 NUA 组的 20.1%。当在 420μmol/L 时发现阈值效应时，SUA 与主要终点之间存在非线性关系。在校正性别、年龄、纽约心脏协会（NYHA）分级、CKD、收缩压（SBP）和钾后，HUA 组的主要终点风险高于 NUA 组（HR：1.40，95%CI：1.14 至 1.72，p=0.001）。此外，SUA 四分位数越高，风险越高（趋势 P 值=0.002）。此外，分层分析表明在无 CKD 的患者中存在更强的相关性（P 交互=0.033）。
高尿酸血症与 HF 患者短期再入院和死亡率增加独立相关。我们的研究结果表明，监测和管理 SUA 可能对改善 HF 患者的预后至关重要。
