Uric Acid as a Predictor of All-Cause Mortality in Heart Failure: A Meta-Analysis

Abstract

Serum uric acid (SUA) is a product of xanthine oxidase (XO). Apoptosis and tissue hypoxia lead to increased purine catabolism, which, in turn, increases XO activity and subsequently SUA levels. The purpose of this study was to perform a meta-analysis to evaluate the evidence supporting SUA as a predictor of all-cause mortality in patients with heart failure (HF) and to determine the SUA cut-off for the increase in risk. A search of the MEDLINE database (1966 to March 2009) supplemented by manual searches of bibliographies of key relevant articles was performed. The authors selected all cohort studies in which SUA was measured and mortality was reported in patients with HF. The pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for all-cause mortality using the fixed-effects method was calculated. The effects of SUA on all-cause mortality at different SUA cut-offs using meta-regression was evaluated. The search strategy yielded 358 studies, of which only 6 met our eligibility criteria. The studies, however, comprised 1456 evaluable patients with HF, with a median ejection fraction of 32% (range, 26%-40%). The RR of all-cause mortality was 2.13 (95% CI, 1.78-2.55) for SUA>6.5 mg/dL compared with <6.5 mg/dL SUA level. There was a linear association (P<.01) between SUA and mortality after 7 mg/dL. Uric acid is an important prognostic marker for all-cause mortality in HF. SUA levels >7 mg/dL are associated with higher all-cause mortality.

On admission serum sodium and uric acid levels predict 30 day rehospitalization or death in patients with acute decompensated heart failure

“…In addition, the prognostic role of serum uric acid (UA) has been established in patients with chronic HF 10, 11, 12, 13. In a recent investigation in patients with acute HF, admission hyperuricemia was shown to be associated with higher risk of death or HF rehospitalization at 6 months 14…”

Uric acid predicts mortality and ischaemic stroke in subjects with diastolic dysfunction: the Tromsø Study 1994–2013

“…6 In a metaanalysis, hyperuricaemia was associated with high all-cause mortality in HF patients. 7 Furthermore, a recent study demonstrated that hyperuricaemia was associated with increased all-cause mortality in patients who were hospitalised for HFpEF. 8 However, the association between UA and DD remains unclear.…”

The relationship between serum uric acid level and concentration of proangiogenic mononuclear progenitor cells in patients with chronic heart failure

“…The effects of SUA on all-cause mortality at different SUA cut-offs in CHF patient population was evaluated using meta-regression. There was a linear association between SUA after 7 mg/dL and mortality [23]. Arguing against a pure protective role of SUA in cardiovascular disease [24], we found that levels of SUA remained independently associated with lowed proangiogenic MPCs after adjusting for parameters with known impact on concentrations of MPCs.…”

“…Probably, these findings might be taken into consideration to be explaining controversial role of SUA in CHF evolution and outcomes. Really, significant association between high SUA level and BMI, diuretic use, some biomarkers, such as NT-pro-BNP, as wells as with hemodynamic performances (E/Ea and LVEF) even beyond declining eGFR was frequently noted in recent investigations [23,25]. Amin et al [26] reported that mild elevated SUA levels in patients with systolic CHF is associated with impaired clinical and hemodynamic profile and might be used as a noninvasive indicator of elevated left ventricular filling pressures.…”