Hyperuricemia in acute heart failure among Indian population – More than an innocent bystander?

Abstract

Context: Hyperuricemia is an abnormally high level of uric acid in the blood. It is a prevalent condition in chronic heart failure, describing increased oxidative stress and inflammation. Although there is evidence that serum uric acid predicts mortality in chronic heart failure, its role as a prognostic marker in acute heart failure had not yet been well assessed in the Indian population. Aims: In this study, our main objective was to determine the use of serum uric acid as a prognostic marker for patients suffering from acute heart failure. Settings and Design: This clinic-based, prospective, population-based study was conducted on patients visiting the intensive care unit in the department of cardiology at a tertiary care center in South India, who were enrolled in the study from July 2016 to July 2017. Subjects and Methods: A total of 146 patients were enrolled in the study. Patients with acute heart failure were included in the test group, whereas other patients were assigned the control group. Patients taking xanthine oxidase inhibitors and patients having a history of chronic kidney disease were excluded from the study. Out of the 146 patients, 74 and 72 patients were included in the test and control arms, respectively. Serum uric acid was measured on day 1, day 2, day 3, and at pre discharge. Statistical Analysis Used: Data were presented as mean ± standard deviation. Independent Student's t-test was used to compare the uric acid levels in the test and control groups.P Results: The mean age of the patients in the test group was 57.05 ± 11.94 and in the control group was 55.77 ± 10.63. The male-to-female ratio in the test group was 40:32 and in the control group was 48:21, showing a male predominance in both the groups. The mean uric acid level in the test group decreased from 8.867 ± 2.349 on day 1 to 7.367 ± 1.801 on predischarge, whereas in the control group, it decreased from 5.571 ± 1.750 on day 1 to 5.15 ± 1.623 on predischarge. It was again confirmed as statistical significance was observed in the difference between day 1 and predischarge results of Student's t-test (P = 0.003). Conclusions: In this study, high serum uric acid was observed in test group patients when compared to that of control group patients. We may conclude that serum uric acid could be a prognostic marker to identify high-risk patients with acute heart failure. Further research needs to be carried out in larger population to reconfirm the results.