入院24小时内血清尿酸水平与急性心力衰竭患者出院后1年内全因死亡的关系

The relationship between serum uric acid levels within 24 h of admission and all-cause mortality within 1 year after discharge in patients with acute heart failure

目的探讨入院24 h内血清尿酸水平与急性心力衰竭(AHF)患者出院后1年内全因死亡的关系。方法选取2018年6月至2021年6月在中国医学科学院阜外医院深圳医院心衰病房住院的AHF患者598例。按入院24 h内血清尿酸中位数496μmol/L分为血清尿酸高水平组(297例,49.7%,>496μmol/L)和血清尿酸低水平组(301例,50.3%,≤496μmol/L)。患者出院后通过门诊或电话随访1年。随访终点事件是全因死亡。采用Kaplan-Meier曲线评估全因死亡累积发生率。采用Cox比例风险回归模型分析血清尿酸水平升高对AHF患者出院后1年内全因死亡的影响。结果与血清尿酸低水平组相比,血清尿酸高水平组男性占比更高,年龄更小,体重指数更高,心功能更差,血肌酐和N末端B型脑钠肽前体(NT-proBNP)水平更高,β受体阻滞剂、袢利尿剂、静脉利尿剂使用比例更高(均P<0.05)。598例AHF患者在1年随访时间内,共87例(14.5%)发生全因死亡,其中血清尿酸高水平组54例(18.2%),血清尿酸低水平组33例(11.0%)。Kaplan-Meier曲线显示,在1年随访期间内,血清尿酸高水平组的全因死亡累积发生率明显高于血清尿酸低水平组(Log-rank检验P=0.012)。校正年龄、性别、体重指数、纽约心脏病协会心功能分级、左心室射血分数、NT-proBNP、血肌酐、β受体阻滞剂和利尿剂的使用后,血清尿酸高水平组AHF患者全因死亡风险是血清尿酸低水平组的1.735倍(P=0.020)。结论入院24 h内血清尿酸水平升高是AHF患者出院1年内全因死亡风险增加的独立危险因素。

Objective To explore the relationship between serum uric acid levels within 24 h of admission and all-cause mortality within 1 year after discharge in patients with acute heart failure(AHF).Methods Totally 598 AHF patients who were hospitalized in the heart failure ward of Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen from June 2018 to June 2021 were selected.According to the median of serum uric acid(496μmol/L)within 24 h of admission,patients were divided into high serum uric acid group(297 cases,49.7%,>496μmol/L)and low serum uric acid group(301 cases,50.3%,≤496μmol/L).Each subject was followed up by outpatient examination or telephone for 1 year.The end point of follow-up was all-cause mortality.The Kaplan-Meier curve was used to evaluate the cumulative incidence of all-cause mortality.Cox proportional hazards regression model was used to analyze the effect of elevated serum uric acid level on all-cause mortality within 1 year after discharge from hospital.Results Compared with the low serum uric acid group,the high serum uric acid group had a higher proportion of males,younger age,higher body mass index,worse heart function,higher serum creatinine and N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)levels,and higher proportion of patients receivingβ-receptor blockers,loop diuretics,and intravenous diuretics(all P<0.05).All-cause death occurred in 87(14.5%)of 598 AHF patients within 1 year of follow-up,including 54(18.2%)in the high serum uric acid group and 33(11.0%)in the low serum uric acid group.The Kaplan-Meier curve showed that during the one-year follow-up period,the cumulative incidence of all-cause death in the high serum uric acid group was significantly higher than that in the low serum uric acid group(Log-rank P=0.012).After adjusting for age,gender,body mass index,New York Heart Association functional class,left ventricular ejection fraction,NT-proBNP,serum creatinine,use ofβ-receptor blockers and diuretics,the risk of all-cause mortality in the high serum uric acid group was 1.735 times higher than that in the low serum uric acid group(P=0.020).Conclusion Elevated serum uric acid level within 24 h of admission is an independent risk factor for increased risk of all-cause death in AHF patients within 1 year after discharge.