Yamamoto H, et al. J Card Fail 2020.
BACKGROUND: 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.
METHODS AND RESULTS: 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 [69-84], 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 (LVEF), 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 endpoint defined as the composite of all-cause death and ADHF re-hospitalization (p=0.013, log-rank test). UA change, but not UA at discharge, was an independent predictor of the primary endpoint (HR 1.30 [IQR 1.04-1.64], P=0.022). Age, estimated glomerular filtration rate, LVEF, dose of loop diuretics, and thiazide prescription at discharge were independently associated with the UA change.
CONCLUSION: In HF patients, UA change through the treatment of ADHF might predict future adverse outcome.