Serum uric acid fluctuations and cardiovascular outcomes in hospitalized acute heart failure patients

Background and aims

This study examined the association between serum uric acid (SUA) fluctuation patterns during hospitalization in acute heart failure (HF) patients and clinical outcomes, a relationship not fully understood.

Methods and results

A cohort of 1403 acute HF patients was enrolled with a median follow-up of 20.5 months. Outcomes assessed included cardiovascular (CV) death and/or heart failure hospitalization (CV death & HHP), CV death alone, and all-cause mortality (ACM). Restricted cubic splines analyzed the relationship between admission SUA levels and outcomes. Patients were categorized based on admission and discharge SUA levels into four groups: 1) Normal SUA at both points (N&N), 2) Elevated SUA at admission, normalized at discharge (H&N), 3) Normal SUA at admission, elevated at discharge (N&H), and 4) Elevated SUA at both points (H&H). Associations between SUA categories and outcomes were assessed using COX multivariate regression analysis. Results showed elevated SUA at admission predicted poor outcomes. However, neither N&H nor H&N groups displayed significant increases in CV death & HHP, CV death, or ACM compared to N&N. The H&H group had the highest risks for CV death (adjusted HR 1.79, 95 % CI 1.10–2.93) and ACM (adjusted HR 1.64, 95 % CI 1.08–2.49), with a non-significant trend towards increased risk of CV death & HHP (adjusted HR 1.79, 95 % CI 0.99–2.93).

Conclusion

Persistently elevated SUA levels during hospitalization were independently associated with adverse cardiovascular outcomes and ACM in patients with acute HF, whereas fluctuations in SUA levels did not exhibit a similar association.