Prognostic Value of Serum Uric Acid in Hospitalized Heart Failure Patients With Preserved Ejection Fraction (from the Japanese Nationwide Multicenter Registry)

Am J Cardiol. 2020 Mar 1;125(5):772-776. doi: 10.1016/j.amjcard.2019.12.003. Epub 2019 Dec 9.

Abstract

Elevated serum uric acid (UA) is associated with an increased risk of cardiovascular disease and worse clinical outcome in patients with cardiovascular disease. Nevertheless, the prognostic value of serum UA level in hospitalized heart failure patients with preserved ejection fraction (HFpEF) has not been fully elucidated. The aim of this study was to investigate whether serum UA level on admission could be associated with subsequent mortality in hospitalized patients with HFpEF. We examined 516 consecutive hospitalized HFpEF (left ventricular ejection fraction ≥50%) patients with decompensated heart failure from our HFpEF-specific multicenter registry who had serum UA data on admission. The primary outcome of interest was all-cause death. During a median follow-up period of 749 (interquartile range 540 to 831) days, 90 (17%) patients died. Higher serum UA level was significantly related to increased incidence of all-cause death (p = 0.016). In addition, patients with higher serum UA (≥6.6 mg/dl, median) and plasma B-type natriuretic peptide (≥401.2 pg/ml, median) levels had the highest incidence of all-cause death in the groups (p = 0.002). In multivariable Cox regression analysis, serum UA was an independent determinant of mortality (hazards ratio 1.23, 95% confidence interval 1.10 to 1.39) even after adjustment for prespecified confounders, renal function and the use of diuretics before admission. In conclusions, higher admission serum UA was an independent determinant of mortality in hospitalized HFpEF patients. Our findings indicate the importance of assessing admission serum UA level for further risk stratification in hospitalized patients with HFpEF.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Aged, 80 and over
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Atrial Fibrillation / epidemiology
  • Cause of Death
  • Comorbidity
  • Female
  • Heart Failure / blood*
  • Heart Failure / drug therapy
  • Heart Failure / epidemiology
  • Heart Failure / physiopathology
  • Hospitalization*
  • Humans
  • Japan / epidemiology
  • Male
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Mortality*
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / blood*
  • Prognosis
  • Proportional Hazards Models
  • Registries
  • Renal Insufficiency, Chronic / epidemiology
  • Sodium Potassium Chloride Symporter Inhibitors / therapeutic use
  • Stroke Volume / physiology
  • Uric Acid / blood*

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Mineralocorticoid Receptor Antagonists
  • Sodium Potassium Chloride Symporter Inhibitors
  • Natriuretic Peptide, Brain
  • Uric Acid