Liao Guang-Zhi, Feng Jia-Yu, Wang Jing-Xi, Zhou Ping, He Chun-Hui, Zhuang Xiao-Feng, Huang Yan, Zhou Qiong, Zhai Mei, Zhang Yu-Hui, Zhang Jian
State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Nutr Metab Cardiovasc Dis. 2025 Jun;35(6):104025. doi: 10.1016/j.numecd.2025.104025. Epub 2025 Mar 24.
This study examined the association between serum uric acid (SUA) fluctuation patterns during hospitalization in acute heart failure (HF) patients and clinical outcomes, a relationship not fully understood.
A cohort of 1403 acute HF patients was enrolled with a median follow-up of 20.5 months. Outcomes assessed included cardiovascular (CV) death and/or heart failure hospitalization (CV death & HHP), CV death alone, and all-cause mortality (ACM). Restricted cubic splines analyzed the relationship between admission SUA levels and outcomes. Patients were categorized based on admission and discharge SUA levels into four groups: 1) Normal SUA at both points (N&N), 2) Elevated SUA at admission, normalized at discharge (H&N), 3) Normal SUA at admission, elevated at discharge (N&H), and 4) Elevated SUA at both points (H&H). Associations between SUA categories and outcomes were assessed using COX multivariate regression analysis. Results showed elevated SUA at admission predicted poor outcomes. However, neither N&H nor H&N groups displayed significant increases in CV death & HHP, CV death, or ACM compared to N&N. The H&H group had the highest risks for CV death (adjusted HR 1.79, 95 % CI 1.10-2.93) and ACM (adjusted HR 1.64, 95 % CI 1.08-2.49), with a non-significant trend towards increased risk of CV death & HHP (adjusted HR 1.79, 95 % CI 0.99-2.93).
Persistently elevated SUA levels during hospitalization were independently associated with adverse cardiovascular outcomes and ACM in patients with acute HF, whereas fluctuations in SUA levels did not exhibit a similar association.
本研究探讨急性心力衰竭（HF）患者住院期间血清尿酸（SUA）波动模式与临床结局之间的关联，该关系尚未完全明确。
纳入1403例急性HF患者队列，中位随访时间为20.5个月。评估的结局包括心血管（CV）死亡和/或心力衰竭住院（CV死亡和HHP）、单纯CV死亡以及全因死亡率（ACM）。采用受限立方样条分析入院时SUA水平与结局之间的关系。根据入院和出院时的SUA水平将患者分为四组：1）两点SUA均正常（N&N），2）入院时SUA升高，出院时恢复正常（H&N），3）入院时SUA正常，出院时升高（N&H），4）两点SUA均升高（H&H）。使用COX多变量回归分析评估SUA类别与结局之间的关联。结果显示入院时SUA升高预示结局不良。然而，与N&N组相比，N&H组和H&N组在CV死亡和HHP、CV死亡或ACM方面均未显示出显著增加。H&H组发生CV死亡（校正HR 1.79，95%CI 1.10 - 2.93）和ACM（校正HR 1.64，95%CI 1.08 - 2.49）的风险最高，CV死亡和HHP风险增加趋势不显著（校正HR 1.79，95%CI 0.99 - 2.93）。
急性HF患者住院期间SUA持续升高与不良心血管结局和ACM独立相关，而SUA水平波动未显示出类似关联。
