Abstract
BACKGROUND: Serum uric acid (UA) has been associated with adverse outcomes in patients with heart failure. However, it remains inconclusive whether such association persists in patients with cardiorenal syndrome (CRS). METHODS: In a nationwide prospective cohort from China, 4907 adults hospitalized for heart failure were enrolled. Of them, 1284 had an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) at admission were included in this study. The Cox regression model was employed to evaluate the relationship between UA levels and mortality, major cardiovascular events (MACE), and hospitalization for heart failure (HHF). Additionally, Harrell's concordance index was utilized to assess the incremental value of UA levels in predicting mortality. RESULTS: During a median follow-up of 3.28 years, hyperuricemia was associated with a 27 % increased risk of all-cause mortality (HR 1.27, 95 % confidence interval [CI] 1.08-1.49) and a 36 % increased risk of cardiovascular mortality (HR 1.36, 95 % CI 1.11-1.65), regardless of patients' eGFR levels. This relationship remained consistent throughout the whole follow-up period. Hyperuricemia increased the risk of 3-month MACE by 39 % (HR 1.39, 95 % CI 1.03-1.88), 3-month HHF by 47 % (HR 1.47, 95 % CI 1.11-1.95), and 1-year MACE by 26 % (HR 1.26, 95 % CI 1.02-1.57). The additive effect of uric acid levels in predicting mortality was also confirmed. CONCLUSIONS: Serum UA levels possess significant value in prognosis of mortality, MACE, and HHF among patients with CRS. These findings underscore the importance of monitoring serum UA in the management of patients with CRS, as UA may provide valuable insights into risk stratification.