The Prognostic Impact of Serum Uric Acid on Disease Severity and 5-Year Mortality in Patients With Idiopathic Pulmonary Artery Hypertension

Abstract

BackgroundSerum uric acid (UA) has long been identified as a prognostic factor of adverse outcomes in pulmonary hypertension. However, there remains a paucity of evidence on patients with idiopathic pulmonary artery hypertension (IPAH) in the era of targeted drug therapy. This study aims to explore the impact of serum UA levels on the disease severity and mortality in patients with IPAH.MethodsConsecutive patients diagnosed with IPAH were enrolled, from which UA levels at baseline and the first follow-up were collected. Patients were divided into groups of “hyperuricemia,” which is defined as serum UA level ≥357 μmol/L in women and ≥420 μmol/L in men, and otherwise “normouricemia.” The potential relationship between UA and hemodynamics at right heart catheterization was investigated. Associations between UA and survival were evaluated by Kaplan-Meier analysis and Cox proportional hazard modeling.ResultsOf 207 patients with IPAH, 121 (58.5%) had hyperuricemia. Higher serum UA levels were associated with lower cardiac index (r = 0.47, p < 0.001) and higher pulmonary vascular resistance (r = 0.36, p < 0.001). During a median follow-up of 34 months, there were 32 deaths recorded, accounting for a 15.5% mortality rate. Patients with hyperuricemia had a significantly lower survival rate than those with normouricemia (log-rank test, p = 0.002). Hyperuricemia at baseline was independently associated with a 2.6-fold increased risk of 5-year death, which was consistent across different subgroups, especially in females and those aged ≥30 years (each p < 0.05). Individuals with higher variability in UA had a higher mortality than those with stable UA (log-rank test, p = 0.024).ConclusionsBaseline hyperuricemia and high variability in serum UA at first follow-up were related to a higher rate of 5-year mortality in patients with IPAH. Closely detecting the UA levels may aid in the early recognition of IPAH patients at higher mortality risk.

Serum uric acid: A risk factor for right ventricular dysfunction and prognosis in heart failure with preserved ejection fraction

“…A previous study in asymptomatic patients with type 2 diabetes demonstrated an independent relationship between UA and biventricular systolic function, regardless of renal function or diabetic control ( 24 ). In patients with idiopathic pulmonary artery hypertension, higher UA levels were suggested to be associated with a lower cardiac index and higher pulmonary vascular resistance ( 25 , 26 ). Another study in patients with ischemic heart disease or dilated cardiomyopathy showed hyperuricemia was associated with elevated right atrial pressures ( 27 ).…”

The role of tolvaptan in pulmonary hypertension: A retrospective study

“…[17][18][19] Furthermore, serum UA is a prognostic factor for adverse outcomes and is associated with higher 5-year mortality rate in patients with PH. [20][21][22] Some studies have demonstrated that TLV increases the serum UA level by decreasing its renal clearance. [23] Furthermore, water intake increased in these studies, which effectively reduced urinary UA supersaturation.…”

Development and Validation of a Nomogram for Predicting Obstructive Sleep Apnea in Patients with Pulmonary Arterial Hypertension

“…All enrolled PAH patients underwent full-night cardiorespiratory PG monitoring via an Embletta device (Medcare, Flaga, Reykjavik, Ireland) as previously described 13 and nocturnal cardiorespiratory signals were recorded. Nasal airflow, finger pulse oximetry, thoracic and abdominal movements, body position, and snoring were recorded to evaluate the respiratory events.…”