Characteristics of Patients with an Abnormally Decreased Plasma Xanthine Oxidoreductase Activity in Acute Heart Failure Who Visited the Emergency Department

Abstract

Background: The factors associated with a low plasma xanthine oxidoreductase (XOR) activity were not elucidated in patients with acute heart failure (AHF). Methods: Two-hundred and twenty-nine AHF patients who visited the emergency department were prospectively analyzed. AHF patients were divided into 3 groups according to the plasma XOR quartiles (Q1 = low-XOR group [n = 57], Q2/Q3 = middle-XOR group [n = 115], and Q4 = high-XOR group [n = 57]). The prognostic nutritional index (PNI) and the controlling nutritional status (CONUT) score were evaluated. Results: The multivariate logistic regression model showed that the nutritional status (PNI: OR 1.044, 95% CI 1.000-1.088; CO-NUT: OR 3.805, 95% CI 1.158-12.498), age, and serum creatinine level were independently associated with a low plasma XOR activity. The Kaplan-Meier curve showed a significantly lower incidence of heart failure events in the low-XOR group than in the middle + high-XOR group (hazard ratio, HR 1.648, 95% CI 1.061-2.559). In particular, a low XOR activity with an increased serum creatinine level (> 1.21 mg/dL) was independently associated with heart failure events (HR 1.937, 95% CI 1.199-3.130). Conclusion: A low plasma XOR activity was associated with malnutrition, renal dysfunction, and aging in AHF. A low XOR activity complicated with renal dysfunction leads to adverse long-term outcomes.

Plasma Xanthine Oxidoreductase Activity Associated with Glycemic Control in Patients with Pre-Dialysis Chronic Kidney Disease

“…Otaki et al [16] investigated plasma XOR activity in patients with chronic heart failure and found that in their lower eGFR group (53 ± 25 mL/min/1.73 m 2 ) to be significantly reduced as compared to the normal eGFR group (68 ± 26 mL/min/1.73 m 2 ). Additionally, Shirakabe et al [45] demonstrated that the serum creatinine level was independently associated with low plasma XOR activity in patients with acute heart failure, while Terawaki et al [19] showed a strong correlation between plasma XOR activity and eGFR ( r = 0.751, p = 0.002) in pre-dialysis CKD patients ( n = 13). We speculate that this discrepancy may have been due to differences in measurement methods used to determine plasma XOR activity.…”

Time‐dependent changes in plasma xanthine oxidoreductase during hospitalization of acute heart failure

“…AHF is recognized as a heterogeneous condition, and its characteristics differ among individuals. We already published that a low plasma XOR activity was associated with malnutrition, renal dysfunction, and aging in AHF 7 . These factors might cause underestimation of plasma XOR activities and affect their prognosis.…”

“…The AHF patients were divided into two groups according to the XOR activity on Day 1: the high‐XOR group (≥100 pmol/h/mL, n = 102) or the low‐XOR group (<100 pmol/h/mL, n = 85). Because the normal range of XOR activity was not established yet, cut‐off value (100 pmol/h/mL) of the present study was defined by the reference of the previous reports in patients with AHF, which the median plasma XOR activity was 77.0 and 104.0 pmol/h/mL, respectively 4,7 . Furthermore, 85 high‐XOR patients were assigned to two groups according to the rate of change in XOR from Day 1 to Day 14: the decreased group (≥50% decrease, n = 70) and the non‐decreased group (<50% decrease, n = 15).…”

“…Because the normal range of XOR activity was not established yet, cut-off value (100 pmol/h/mL) of the present study was defined by the reference of the previous reports in patients with AHF, which the median plasma XOR activity was 77.0 and 104.0 pmol/ h/mL, respectively. 4,7 Furthermore, 85 high-XOR patients were assigned to two groups according to the rate of change in XOR from Day 1 to Day 14: the decreased group (≥50% decrease, n = 70) and the non-decreased group (<50% decrease, n = 15). Cut-off value of the decreased or nondecreased group was decided by the median value (52%) of the rate of change in XOR from Day 1 to Day 14.…”

“…We already published that a low plasma XOR activity was associated with malnutrition, renal dysfunction, and aging in AHF. 7 These factors might cause underestimation of plasma XOR activities and affect their prognosis. The interaction analysis should be analysed in future studies.…”