Heart India

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 8  |  Issue : 1  |  Page : 17--20

Hyperuricemia in acute heart failure among Indian population – More than an innocent bystander?


Sheeba George1, Prannoy George Mathen2, Pratheesh George Mathen3,  
1 Department of Cardiology, Jubilee Memorial Hospital, Thiruvananthapuram, Kerala, India
2 Department of Emergency Medicine and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
3 Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Prannoy George Mathen
Department of Emergency Medicine and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala
India

Abstract

Context: Hyperuricemia is an abnormally high level of uric acid in the blood. It is a prevalent condition in chronic heart failure, describing increased oxidative stress and inflammation. Although there is evidence that serum uric acid predicts mortality in chronic heart failure, its role as a prognostic marker in acute heart failure had not yet been well assessed in the Indian population. Aims: In this study, our main objective was to determine the use of serum uric acid as a prognostic marker for patients suffering from acute heart failure. Settings and Design: This clinic-based, prospective, population-based study was conducted on patients visiting the intensive care unit in the department of cardiology at a tertiary care center in South India, who were enrolled in the study from July 2016 to July 2017. Subjects and Methods: A total of 146 patients were enrolled in the study. Patients with acute heart failure were included in the test group, whereas other patients were assigned the control group. Patients taking xanthine oxidase inhibitors and patients having a history of chronic kidney disease were excluded from the study. Out of the 146 patients, 74 and 72 patients were included in the test and control arms, respectively. Serum uric acid was measured on day 1, day 2, day 3, and at pre discharge. Statistical Analysis Used: Data were presented as mean ± standard deviation. Independent Student's t-test was used to compare the uric acid levels in the test and control groups.P < 0.05 was considered statistically significant. Results: The mean age of the patients in the test group was 57.05 ± 11.94 and in the control group was 55.77 ± 10.63. The male-to-female ratio in the test group was 40:32 and in the control group was 48:21, showing a male predominance in both the groups. The mean uric acid level in the test group decreased from 8.867 ± 2.349 on day 1 to 7.367 ± 1.801 on predischarge, whereas in the control group, it decreased from 5.571 ± 1.750 on day 1 to 5.15 ± 1.623 on predischarge. It was again confirmed as statistical significance was observed in the difference between day 1 and predischarge results of Student's t-test (P = 0.003). Conclusions: In this study, high serum uric acid was observed in test group patients when compared to that of control group patients. We may conclude that serum uric acid could be a prognostic marker to identify high-risk patients with acute heart failure. Further research needs to be carried out in larger population to reconfirm the results.



How to cite this article:
George S, Mathen PG, Mathen PG. Hyperuricemia in acute heart failure among Indian population – More than an innocent bystander?.Heart India 2020;8:17-20


How to cite this URL:
George S, Mathen PG, Mathen PG. Hyperuricemia in acute heart failure among Indian population – More than an innocent bystander?. Heart India [serial online] 2020 [cited 2020 Nov 25 ];8:17-20
Available from: https://www.heartindia.net/text.asp?2020/8/1/17/281876


Full Text



 Introduction



Heart failure is one of the most prominent clinical diagnoses in modern medicine, be it from the clinical, prognostic, epidemiological, or socioeconomic point of view. In times of flowchart-guided diagnostic and therapeutic decision trees, there is a growing need for diagnostic tools to objectively channel our options as early as possible.[1]

Epidemiological studies have found an association between elevated serum uric acid with increased vascular event rate and mortality in patients with hypertension, diabetes, and prior cardiovascular disease.[2] Increased uric acid levels are also common in chronic heart failure,[2] with an increased prevalence as diseases progress.

Hyperuricemia is an abnormally high level of uric acid in the blood. It is a prevalent condition in chronic heart failure, describing increased oxidative stress and inflammation. Uric acid is the end product of purine metabolism, and its levels are often elevated in patients with chronic heart failure, as a consequence of increased production and probably smaller renal excretion.[3],[4] Prospective studies suggest that uric acid levels are markers of a deteriorated oxidative metabolism, hyperinsulinemia, inflammatory cytokine activation, and endothelial dysfunction, all of which are present in patients with heart failure.[3],[4],[5]

Although the mechanisms by which uric acid may play a pathogenic role in cardiovascular disease are unclear, hyperuricemia is associated with deleterious effects on endothelial dysfunction, oxidative metabolism, platelet adhesiveness, hemorheology, and aggregation. There is evidence that high uric acid is a negative prognostic factor in patients with mild-to-severe heart failure.[6],[7]

Even though there is evidence that serum uric acid predicts mortality in chronic heart failure, its role as a prognostic biomarker in acute heart failure has not yet been well assessed in the Indian population. In this study, our main objective was to determine the use of uric acid as a possible prognostic marker for patients suffering from acute heart failure.

 Subjects and Methods



This was a clinic-based, prospective, population-based study conducted on patients visiting the intensive care unit in the department of cardiology at a tertiary care center, who were enrolled in the study from July 2016 to July 2017.

Patients with acute heart failure were included in the test group, whereas other patients were assigned the control group. Patients taking xanthine oxidase inhibitors and patients having a history of chronic kidney disease were excluded from the study. Out of 146 patients, 74 and 72 patients were included in the test and control arms, respectively. Serum uric acid level was measured on day 1, day 2, day 3, and at predischarge.

Data were presented as mean ± standard deviation (SD). Independent Student's t-test was used to compare uric acid levels in the test and control groups. P <0.05 was considered statistically significant. Statistical analysis was done using IBM SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). All categorical variables were represented as percentages, and all continuous variables were represented as mean ± standard deviation. To test the statistical significance of the association of categorical variables with the outcome, Chi-square test was used. P < 0.05 was considered statistically significant.

 Results



Demographic analysis of the study population revealed that the mean age of the patients in the test group was 57.05 ± 11.94 and in the control group, it was 55.77 ± 10.63. The male-to-female ratio in the test group was 40:32 and in the control group, it was 48:21, showing a male predominance in both the groups. The mean value of the uric acid levels in both study groups is shown in [Figure 1].{Figure 1}

The mean uric acid level in the test group decreased from 8.867 ± 2.349 on day 1 to 7.367 ± 1.801 on predischarge, whereas in the control group, it decreased from 5.571 ± 1.750 on day 1 to 5.15 ± 1.623 on predischarge as shown in [Table 1].{Table 1}

The differences between the mean levels of uric acid within days 1 and 2, days 1 and 3, and days 1 and predischarge represent [Figure 2] that throughout the study, the test group had a significantly higher difference in mean levels as compared to the control group levels.{Figure 2}

Furthermore, ANOVA [Table 2] and post hoc Sidak [Table 3] tests were carried out to determine the significance of the results of each study period. Their results showed that the significance was seen between days 1, 2, and 3 versus predischarge, with P < 0.001, throughout the study.{Table 2}{Table 3}

Finally, we observed that in the case of the test group, there was a rapid and significant decrease in the uric acid levels after day 2 as compared to that of the control group participants [Figure 3].{Figure 3}

 Conclusions



In this study, we observed high serum uric acid levels in the test group patients when compared to that of control group patients. It can be concluded that serum uric acid level could be a prognostic biomarker to identify high-risk patients with acute heart failure. Further research needs to be carried out in larger population to reconfirm the results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Doehner W, von Haehling S, Anker SD. Uric acid as a prognostic marker in acute heart failure – New expectations from an old molecule. Eur J Heart Fail 2007;9:437-9.
2Alimonda AL, Núñez J, Núñez E, Husser O, Sanchis J, Bodí V, et al. Hyperuricemia in acute heart failure. More than a simple spectator? Eur J Intern Med 2009;20:74-9.
3Leyva F, Chua TP, Anker SD, Coats AJ. Uric acid in chronic heart failure: A measure of the anaerobic threshold. Metabolism 1998;47:1156-9.
4Leyva F, Anker S, Swan JW, Godsland IF, Wingrove CS, Chua TP, et al. Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure. Eur Heart J 1997;18:858-65.
5Leyva F, Anker SD, Godsland IF, Teixeira M, Hellewell PG, Kox WJ, et al. Uric acid in chronic heart failure: A marker of chronic inflammation. Eur Heart J 1998;19:1814-22.
6Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, et al. Uric acid and survival in chronic heart failure: Validation and application in metabolic, functional, and hemodynamic staging. Circulation 2003;107:1991-7.
7Ochiai ME, Barretto AC, Oliveira MT Jr., Munhoz RT, Morgado PC, Ramires JA. Uric acid renal excretion and renal insufficiency in decompensated severe heart failure. Eur J Heart Fail 2005;7:468-74.