Hyperuricemia as a prognostic marker of heart failure readmission and all-cause mortality in patients with acute decompensation of heart failure: a 5-year single center experience

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hyperuricemia is a risk factor for cardiovascular disease. Aim to determine the prognostic value of asymptomatic hyperuricemia for stratifying the risk of complications in patients with Acute Decompensation of Heart Failure (ADHF) for predicting Heart Failure (HF) readmission and all-cause mortality Material and methods The study population consisted of 111 ADHF patients (78 men) aged 68 ± 11 years old. Asymptomatic hyperuricemia was defined as a serum UA (uric acid) level > 420 µmol/L (7 mg/dL) in men and >360 µmol/L (6 mg/dL) in women. Study duration was 5 years, the primary end points were HF readmissions and all-cause mortality and combined outcome (HF readmissions + all - cause mortality). Secondary endpoints were uric acid levels, signs of cardiovascular disease and severity of heart failure. ROC curve analysis for predicting primary end points identified the following cut-off of UA: >451 μmol/ L (7,58 mg/dL) (Sensitivity: 70%, Specificity: 56%) Results Asymptomatic hyperuricemia (HU) was observed in 66, 3% men and 33,7% women ADHF patients. The mean UA level in HU group was 486,1 ± 145 µmol/l (8,17 ± 2,43 mg/dl). Asymptomatic HU group compared with group with normal UA characterized by highest number of patients with HFrEF phenotype [53,8% vs. 27,2%, p<0,05], lowest incidence of the HFpEF phenotype [26,9% vs. 51,5%, p > 0,05], highest number of patients with dilatation of the right atrium [84,6% vs. 63,6%, p = 0,007], greater dilatation of the right ventricle [3,4 ± 0,64 cm vs 3,1 ± 0,51 cm, p = 0,011], inferior vena cava [2,34 ± 0,39 mm vs 2,1 ± 0,33 mm, p = 0,017] and higher pulmonary pressure [56 mmHg (45 - 68) vs 40 mmHg (34 - 65), p = 0,012] respectively. Cox and Kaplan Meier's analysis showed that uric acid values > 451 µmol/L (7,58 mg/dL) were associated with a higher likelihood of HF readmissions [HR 2,19, 95% CI (1,12–4,23), p=0,02] Log Rank: 0,011 and combined outcome (HF readmissions + all-cause mortality) [HR 1,77, 95% CI (1,00-3,11), p = 0,04] in patients with ADHF. Conclusion Hyperuricemia can be used as prognostic marker of heart failure readmission and all-cause mortality in patients with ADHF.