Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery

Lazzeroni, Davide; Bini, Matteo; Camaiora, Umberto; Castiglioni, Paolo; Moderato, Luca; Bosi, Davide; Geroldi, Simone; Ugolotti, Pietro Tito; Brambilla, Lorenzo; Brambilla, Valerio; Coruzzi, Paolo

doi:10.1177/2047487317744045

Cited by 26 publications

(26 citation statements)

References 41 publications

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“…Clinical studies also indicated the association between UA and several cardiovascular diseases such as hypertension [22], coronary artery disease [23], heart failure [24] and atrial fibrillation [25]. Increased UA level was also found to be risk factor of cardiovascular disease mortality [13], poorer outcome after coronary artery bypass grafting and cardiac valve surgery [14,15].…”

Section: Discussionmentioning

confidence: 96%

“…Several experimental and human studies have shown the association between serum UA level and endothelial dysfunction [10], oxidative stress [11] and systemic inflammation [12]. Epidemiological studies suggested that increased serum UA level was associated with increased cardiovascular disease mortality [13], poorer survival after coronary artery bypass grafting and cardiac valve surgery [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection

Zhang

Lü

et al. 2020

J Cardiothorac Surg

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Background: The present study aimed to evaluate the value of admission serum uric acid (UA) level in predicting in-hospital risk of death in patients with acute type A aortic dissection (AAAD). Methods: From January 2016 to June 2019, 186 consecutive patients with AAAD who underwent thoracic aortic surgery were retrospectively studied. Serum UA levels were measured on admission. Forward conditional logistic regression was performed to identify independent risk factors for in-hospital death. Receiver operating characteristic (ROC) analysis was performed to assess the most clinical useful level of serum UA for predicting postoperative inhospital mortality. Results: Increased level of serum UA was found in non-survivors compared with those survived (446 ± 123 vs 371 ± 111 umol/L, p < 0.001). Age (OR = 1.063, 95% CI 1.016-1.112, p = 0.009), UA (OR = 1.006, 95% CI 1.002-1.010, p = 0.002), D-dimer (OR = 1.025, 95% CI 1.005-1.013, p = 0.012), operation time (OR = 1.009, 95% CI 1.005-1.013, p < 0.001) and extent of aortic replacement (OR = 0.412, 95% CI 0.220-0.768, p = 0.005) were identified as independent risk factors of in-hospital mortality in AAAD patients. The best cutoff value of admission serum UA in predicting in-hospital mortality was determined to be 415 umol/L. Subgroup analysis showed that in the subgroup of total arch replacement, UA was significantly associated with in-hospital death (OR = 1.010, 95% CI 1.005-1.015, p < 0.001), while in patients underwent ascending aorta replacement or hemiarch replacement, the relationship was no longer significant (OR = 1.001, 95% CI 0.996-1.006, p = 0.611). Conclusions: Elevated serum UA level on admission is an independent predictor of in-hospital mortality in patients with AAAD.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection

Zhang

Lü

et al. 2020

J Cardiothorac Surg

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“…Our model suggests a significant association between hyperuricemia and an adverse outcome of depressive symptoms. It has been shown that elevated serum uric acid levels predict adverse outcomes after myocardial revascularisation or cardiac valve surgery [43]. Some authors maintain that the purinergic system is involved in the regulation of mood [44, 45], but current data regarding the relationship between serum uric acid levels and depression is inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study

et al. 2019

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BackgroundDepressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD.MethodsBased on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach.ResultsHigher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results.ConclusionOur findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors.Trial registrationwww.clinicaltrials.gov NCT00705965 (registered 27th of June, 2008).www.isrctn.com ISRCTN76240576 (registered 27th of March, 2008).Electronic supplementary materialThe online version of this article (10.1186/s12888-019-2026-6) contains supplementary material, which is available to authorized users.

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“…One study shows that during a follow up of 2-3 years, with increase of serum UA level in CHD patients about 60 years old, the risk of all-cause mortality and cardiac death increases significantly [10] . Baseline serum UA level presents favorable values in evaluating and predicting the prognosis of patients with different subtypes of ACS [11][12][13][14] . In fact, hyperuricemia is closely related to DM.…”

Section: Introductionmentioning

confidence: 99%

Evaluation on prognostic ability of serum uric acid for very old acute coronary syndrome patients with diabetes mellitus

Jiao¹,

Wang²,

Xi³

et al. 2020

Preprint

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Background and aims This study sought to evaluate the prognostic power of serum uric acid (UA) in predicting adverse events of very old acute coronary syndrome (ACS) patients with diabetes mellitus (DM). Patients and methods This analysis involved 718 ACS patients >80 years old who were collected general clinical data and baseline blood biochemical indicators prospectively from January 2006 to December 2012, and these patients were classified into two groups based on DM, then followed up after discharge. Kaplan–Meier method was performed for major adverse cardiac events (MACE) rates and all-cause mortality. Multivariate Cox regression was performed to analyze the relationship between UA level and long-term clinical prognosis. Receiver operating characteristic (ROC) curve was analyzed to predict the cutoff value of UA of the very old ACS patients with DM. Results There were 242 and 476 patients in groups DM and non-DM(NDM) and the follow-up time after discharge was 40-120 months (median: 63 months; interquartile range: 51–74 months). The differences in all-cause mortality, cardiac mortality and MACE rates in DM and NDM patients between the control group were statistically significant (P=0.001). All-cause mortality, cardiac mortality and MACE incidence in DM patients with moderate and high UA level were significantly higher than those in control group (P=0.001). There were statistically significant differences in long-term survival rates among the ACS groups (P=0.001), and long-term survival rates decreased significantly with the increase of UA level. UA (OR=2.106, 95%CI=1.244-3.568, P=0.006) was found to be an independent risk factor for all-cause mortality and MACE in very old ACS patients with DM. The cutoff value of UA was 353.6μmol/L (sensitivity: 67.4%; specificity: 65.7%). The elevation of serum UA level play an important role in predicting the development of all-cause mortality in elderly ACS patients with DM. Conclusion Serum UA level is a strong independent predictor of long-term all-cause death and MACE in very old ACS patients with DM.

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Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery

Cited by 26 publications

References 41 publications

Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection

Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection

Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study

Evaluation on prognostic ability of serum uric acid for very old acute coronary syndrome patients with diabetes mellitus

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