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Uric acid, allopurinol therapy, and mortality in patients with acute heart failure--results of the Acute HEart FAilure Database registry
Journal of Critical Care, 06/15/2012
Clinical Article
Malek F et al. – In patients with acute heart failure (AHF), increased uric acid (UA) levels and documented allopurinol therapy for hyperuricemia were associated with increased hospital and long–term mortality. Allopurinol therapy is not a cause but the identifier of the subjects at risk.
Methods- The study included 1255 patients who were admitted to the AHEAD participating centers with acute decompensated chronic heart failure, de novo heart failure, or cardiogenic shock between September 2006 and October 2009 and who had information about serum UA concentration available at the time of hospital admission.
- The hospital and long–term mortality was followed using the centralized database of the Ministry of Health, Czech Republic.
- The mean age of the cohort was 73.4years, the female population represented 43%, the median hospital stay was 8days, and the mean hospital mortality was 7.6%.
- The median UA concentration of the patients with AHF was 432µmol/L (7.26mg/dL), the median estimated glomerular filtration rate (eGFR) was 49.0mL/min, and N–terminal pro–brain natriuretic peptide level was 5510pg/mL.
- Among other laboratory variables, UA concentration greater than 515µmol/L (8.67mg/dL) was associated with increased hospital mortality (P<.001), as well as eGFR less than 30mL/min (P<.001), Na 135mmol/L or less, and positive troponin.
- Uric acid concentration greater than 500µmol/L (8.41mg/dL) was associated with increased long–term mortality (P<.001), followed by eGFR less than 30mL/min (P<.001), Na 135mmol/L or less, and hemoglobin level lower than 130g/L (P<.001).
- The 1–year survival rate of patients discharged from hospital (n=1159) was 75.6%, and the 2–year rate was 66.8%.
- Survival of patients treated with allopurinol for hyperuricemia was significantly lower compared with untreated subjects (70.1 vs 77.2 for 1–year survival and 60.3 vs 68.5 for 2–year survival).