Abstract
BackgroundSerum uric acid (UA) has long been identified as a prognostic factor of adverse outcomes in pulmonary hypertension. However, there remains a paucity of evidence on patients with idiopathic pulmonary artery hypertension (IPAH) in the era of targeted drug therapy. This study aims to explore the impact of serum UA levels on the disease severity and mortality in patients with IPAH.MethodsConsecutive patients diagnosed with IPAH were enrolled, from which UA levels at baseline and the first follow-up were collected. Patients were divided into groups of “hyperuricemia,” which is defined as serum UA level ≥357 μmol/L in women and ≥420 μmol/L in men, and otherwise “normouricemia.” The potential relationship between UA and hemodynamics at right heart catheterization was investigated. Associations between UA and survival were evaluated by Kaplan-Meier analysis and Cox proportional hazard modeling.ResultsOf 207 patients with IPAH, 121 (58.5%) had hyperuricemia. Higher serum UA levels were associated with lower cardiac index (r = 0.47, p < 0.001) and higher pulmonary vascular resistance (r = 0.36, p < 0.001). During a median follow-up of 34 months, there were 32 deaths recorded, accounting for a 15.5% mortality rate. Patients with hyperuricemia had a significantly lower survival rate than those with normouricemia (log-rank test, p = 0.002). Hyperuricemia at baseline was independently associated with a 2.6-fold increased risk of 5-year death, which was consistent across different subgroups, especially in females and those aged ≥30 years (each p < 0.05). Individuals with higher variability in UA had a higher mortality than those with stable UA (log-rank test, p = 0.024).ConclusionsBaseline hyperuricemia and high variability in serum UA at first follow-up were related to a higher rate of 5-year mortality in patients with IPAH. Closely detecting the UA levels may aid in the early recognition of IPAH patients at higher mortality risk.
Highlights
Pulmonary artery hypertension (PAH) is a devastating condition characterized by progressive remodeling in the pulmonary vasculature, leading to increased pulmonary resistance, right ventricular failure, and even death [1]
These patients’ demographic data [including body mass index (BMI)], World Health Organization (WHO) functional classification, primary laboratory results, serum uric acid (UA) levels, and hemodynamic parameters derived from right heart catheterization (RHC) were gathered and analyzed
We investigated the utility of serum UA as a predictor of disease severity and long-term mortality in patients with idiopathic pulmonary artery hypertension (IPAH)
Summary
Pulmonary artery hypertension (PAH) is a devastating condition characterized by progressive remodeling in the pulmonary vasculature, leading to increased pulmonary resistance, right ventricular failure, and even death [1]. Echocardiographic estimates, commonly used to screen for the presence of pulmonary hypertension, are somehow poorly associated with invasive hemodynamic measures at right heart catheterization (RHC) [4]. This leaves the clinicians with limited tools to non-invasively assess the presence or the severity of PAH. Hyperuricemia has long been a poor prognostic factor in IPAH, yet before the era of current therapeutic management [10]. Serum uric acid (UA) has long been identified as a prognostic factor of adverse outcomes in pulmonary hypertension. There remains a paucity of evidence on patients with idiopathic pulmonary artery hypertension (IPAH) in the era of targeted drug therapy.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
