Uric acid variation as a predictor of short- and long-term mortality in acute decompensated heart failure
F Bahouth, J Khoury, N Andria, Z AzzamAbstract
Background
Acute decompensated heart failure is a life-threatening disease, with a high rate of incidence of 10-12/1000 person/year among adults older than 50 years, and more than 10% of adults older than 70 years. Treatment depends mostly on clinical volemic status, pulmonary congestion in radiologic tests, and renal function and serum electrolytes. However, factors that reflect cardiologic-volemic-renal status, that may guide treatment and can be used for prognostication, is still lacking. We aim to study the change in uric acid during hospitalization (uric acid variation) as a predictor of overall mortality.
Methods
All patients first hospitalization with a primary diagnosis of acute decompensated heart failure between 1/1/2014-31/12/2024, in a Health Care Campus were included in the study. Demographic data, background history and medications, lab tests during hospitalization and mortality dates were collected.
Results
During the study time, 2717 patients fulfilled the inclusion criteria; among them 317 patients did lack any data, and 2400 were included in the study, with 51.6% death rate within 1 year. Uric acid on admission, on discharge, relative change and absolute change was found to have a significant prediction of mortality P<0.001, with relative change being the strongest predictor (OR=2.5, P<0.01). Multivariate models included uric acid relative change, minimal systolic blood pressure, length of stay, BUN at discharge and at admission, creatinine at discharge and maximal levels predicted 30-day mortality for 30 days with ROC AUC = 0.854, and the same model excluding BUN at admission and discharge predicted 90-day mortality ROC AOC = 0.81- and 1-year mortality ROC AUC =0.77.
Conclusion
uric acid levels can change during hospitalization due to volemic status, renal function and treatment. Change in uric acid can predict mortality. A model that includes uric acid has a great potential for following up acute decompensated heart failure.