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Hyperuricaemia predicts poor outcome in patients with mild to moderate chronic heart failure

Authors
Journal
International Journal of Cardiology
0167-5273
Publisher
Elsevier
Publication Date
Volume
115
Issue
2
Identifiers
DOI: 10.1016/j.ijcard.2005.10.033
Keywords
  • Chronic Heart Failure
  • Uric Acid
  • Prognosis
Disciplines
  • Biology
  • Medicine

Abstract

Abstract Background In severe chronic heart failure (CHF) elevated serum levels of uric acid (UA) predict poor survival. This study investigates whether hyperuricaemia (defined as serum UA level ≥ 6.5 mg/dL) extends its prognostic value on population with less advanced CHF. Methods We studied 119 consecutive patients with stable, mild–moderate CHF (88 men, age: 64 ± 11 years, NYHA class I/II/III: 9/65/45, LVEF: 32 ± 8%). Results Serum UA level (mean: 6.2 ± 2.0 mg/dL, range: 2.0–16.2 mg/dL) increased in parallel to CHF severity expressed as NYHA class (4.9 ± 1.1 vs. 5.7 ± 1.5 vs. 7.2 ± 2.4 mg/dL, NYHA I vs. II vs. III; NYHA I, II vs. III, p < 0.01), inversely correlated with peak oxygen consumption ( r = − 0.39, p < 0.01) and LVEF ( r = − 0.31, p < 0.01), but not with renal function (expressed as creatinine clearance calculated from Cockcroft–Gault formula; r = − 0.14, p > 0.1), and predicted inflammatory status as evidenced by the correlation with C-reactive protein ( r = 0.31, p = 0.003). Hyperuricaemia was detected in 48 (40%) patients. During follow-up (mean: 580 ± 209 days, > 18 months in all survivors), 27 (23%) patients died. Hyperuricaemia was related to impaired survival in univariate (HR 2.8, 95%CI: 1.3–6.1, p = 0.01) and multivariate analyses (adjusted for NYHA class and impaired renal function—the only mortality predictors in this population; p < 0.05). The 18-month survival for CHF patients with hyperuricaemia was 71% (95% CI: 58–84%) vs. 89% (95% CI: 81–96%) in those with normal UA level ( p = 0.01). Conclusion In patients with mild–moderate CHF, hyperuricaemia predicts exercise intolerance and inflammatory activation and is strongly and independently related to poor prognosis. Whether elevated serum UA level may become a novel therapeutic target in CHF, deserves further studies.

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