Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2024

Open Access 01-12-2024 | Heart Failure | Research

Could admission level of uric acid predict total diuretic dose in acute heart failure?

Authors: Maryam Chenaghlou, Fatemeh Abedi mahzoon, Sina Hamzehzadeh, Ali Norouzi, Hadi Sahrai, Nasibeh Mohammadi, Negin Khadem haghighi, Mirsaeed Abdollahi, Mohammadreza Taban Sadeghi, Erfan Banisefid

Published in: BMC Cardiovascular Disorders | Issue 1/2024

Login to get access

Abstract

Background

Recent studies have shown that increases in serum UA levels are associated with adverse clinical outcomes in patients with chronic heart failure (CHF); the aim of this study was to determine the relationship between serum uric acid and total diuretic dose received during hospitalization in hospitalized patients with acute exacerbation of heart failure. The main purpose of this study is to determine the role of uric acid as a biomarker that can be a substitute for pro-BNP in clinical evaluation and the need for diuretics in hospitalized patients with acute heart failure.

Methods

After approving the plan in the Research Council of the Heart Department and obtaining an ethical code from the Regional Committee on Research Ethics (Human Subjects Studies), the researcher referred to the archives of our center, the case of 100 patients diagnosed with acute heart failure. Cardiac patients were selected, and the information required for the study was collected using a pre-prepared data collection form, and the information was entered into SPSS software after categorization and appropriate analysis and statistical tests were performed on it. Were performed and in all statistical tests the statistical significance level was considered 0.05:

Results

100 patients with acute heart failure were included in this study with a mean age of 63.43 ± 14.78 years. 66% of them were men. The mean dose of furosemide in these patients was 680.92 ± 377.47 mg and the mean serum uric acid level in these patients was 8.55 ± 2.50 mg / dL. In the study of the relationship between the variables, there was a significant relationship between the dose of furosemide received with the serum level of serum uric acid (P = 0.017, r = 0.248 and P = 0.009, r = -0.267, respectively). There is also a significant relationship between serum uric acid level and patient mortality (P = 0.013, r = 0.247). However this relationship lost its significance after multivariate analysis.

Conclusion

There is a significant relationship between serum uric acid level and diuretic use. However, in-hospital mortality is not related to uric acid levels at admission.
Appendix
Available only for authorised users
Literature
1.
go back to reference Snipelisky D, Chaudhry SP, Stewart GC. The many faces of Heart Failure. Card Electrophysiol Clin. 2019;11(1):11–20.PubMedCrossRef Snipelisky D, Chaudhry SP, Stewart GC. The many faces of Heart Failure. Card Electrophysiol Clin. 2019;11(1):11–20.PubMedCrossRef
2.
go back to reference Mendez GF, Cowie MR. The epidemiological features of Heart Failure in developing countries: a review of the literature. Int J Cardiol. 2001;80(2–3):213–9.PubMedCrossRef Mendez GF, Cowie MR. The epidemiological features of Heart Failure in developing countries: a review of the literature. Int J Cardiol. 2001;80(2–3):213–9.PubMedCrossRef
3.
go back to reference Goetze JP, Bruneau BG, Ramos HR, Ogawa T, de Bold MK, de Bold AJ. Cardiac natriuretic peptides. Nat Rev Cardiol. 2020;17(11):698–717.PubMedCrossRef Goetze JP, Bruneau BG, Ramos HR, Ogawa T, de Bold MK, de Bold AJ. Cardiac natriuretic peptides. Nat Rev Cardiol. 2020;17(11):698–717.PubMedCrossRef
4.
go back to reference Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA Guideline for the management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–e61.PubMedCrossRef Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA Guideline for the management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137–e61.PubMedCrossRef
5.
go back to reference Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of Heart Failure. N Engl J Med. 2002;347(3):161–7.PubMedCrossRef Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of Heart Failure. N Engl J Med. 2002;347(3):161–7.PubMedCrossRef
6.
go back to reference Fonarow GC, Peacock WF, Phillips CO, Givertz MM, Lopatin M. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated Heart Failure. J Am Coll Cardiol. 2007;49(19):1943–50.PubMedCrossRef Fonarow GC, Peacock WF, Phillips CO, Givertz MM, Lopatin M. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated Heart Failure. J Am Coll Cardiol. 2007;49(19):1943–50.PubMedCrossRef
7.
go back to reference Januzzi JL Jr., Sakhuja R, O’Donoghue M, Baggish AL, Anwaruddin S, Chae CU, et al. Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med. 2006;166(3):315–20.PubMedCrossRef Januzzi JL Jr., Sakhuja R, O’Donoghue M, Baggish AL, Anwaruddin S, Chae CU, et al. Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med. 2006;166(3):315–20.PubMedCrossRef
8.
go back to reference Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized Heart Failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP study. Eur Heart J. 2006;27(3):330–7.PubMedCrossRef Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized Heart Failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP study. Eur Heart J. 2006;27(3):330–7.PubMedCrossRef
10.
go back to reference Nohria A, Lewis E, Stevenson LW. Medical management of advanced Heart Failure. JAMA. 2002;287(5):628–40.PubMedCrossRef Nohria A, Lewis E, Stevenson LW. Medical management of advanced Heart Failure. JAMA. 2002;287(5):628–40.PubMedCrossRef
11.
go back to reference Figueroa MS, Peters JI. Congestive Heart Failure: diagnosis, pathophysiology, therapy, and implications for respiratory care. Respir Care. 2006;51(4):403–12.PubMed Figueroa MS, Peters JI. Congestive Heart Failure: diagnosis, pathophysiology, therapy, and implications for respiratory care. Respir Care. 2006;51(4):403–12.PubMed
12.
go back to reference Grayson PC, Kim SY, LaValley M, Choi HK. Hyperuricemia and incident Hypertension: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2011;63(1):102–10.PubMedCrossRef Grayson PC, Kim SY, LaValley M, Choi HK. Hyperuricemia and incident Hypertension: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2011;63(1):102–10.PubMedCrossRef
14.
go back to reference Palazzuoli A, Ruocco G, De Vivo O, Nuti R, McCullough PA. Prevalence of Hyperuricemia in patients with Acute Heart Failure with either reduced or preserved ejection fraction. Am J Cardiol. 2017;120(7):1146–50.PubMedCrossRef Palazzuoli A, Ruocco G, De Vivo O, Nuti R, McCullough PA. Prevalence of Hyperuricemia in patients with Acute Heart Failure with either reduced or preserved ejection fraction. Am J Cardiol. 2017;120(7):1146–50.PubMedCrossRef
15.
go back to reference Mantovani A, Targher G, Temporelli PL, Lucci D, Gonzini L, Nicolosi GL, et al. Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic Heart Failure: a post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza Nella Insufficienza Cardiaca-Heart failure) trial. Metabolism. 2018;83:205–15.PubMedCrossRef Mantovani A, Targher G, Temporelli PL, Lucci D, Gonzini L, Nicolosi GL, et al. Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic Heart Failure: a post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza Nella Insufficienza Cardiaca-Heart failure) trial. Metabolism. 2018;83:205–15.PubMedCrossRef
16.
go back to reference Tamariz L, Harzand A, Palacio A, Verma S, Jones J, Hare J. Uric acid as a predictor of all-cause mortality in Heart Failure: a meta-analysis. Congest Heart Fail. 2011;17(1):25–30.PubMedCrossRef Tamariz L, Harzand A, Palacio A, Verma S, Jones J, Hare J. Uric acid as a predictor of all-cause mortality in Heart Failure: a meta-analysis. Congest Heart Fail. 2011;17(1):25–30.PubMedCrossRef
17.
go back to reference Kalogeropoulos AP, Georgiopoulou VV, Giamouzis G, Smith AL, Agha SA, Waheed S, et al. Utility of the Seattle Heart Failure Model in patients with advanced Heart Failure. J Am Coll Cardiol. 2009;53(4):334–42.PubMedCrossRef Kalogeropoulos AP, Georgiopoulou VV, Giamouzis G, Smith AL, Agha SA, Waheed S, et al. Utility of the Seattle Heart Failure Model in patients with advanced Heart Failure. J Am Coll Cardiol. 2009;53(4):334–42.PubMedCrossRef
18.
go back to reference Manzano L, Babalis D, Roughton M, Shibata M, Anker SD, Ghio S, et al. Predictors of clinical outcomes in elderly patients with Heart Failure. Eur J Heart Fail. 2011;13(5):528–36.PubMedCrossRef Manzano L, Babalis D, Roughton M, Shibata M, Anker SD, Ghio S, et al. Predictors of clinical outcomes in elderly patients with Heart Failure. Eur J Heart Fail. 2011;13(5):528–36.PubMedCrossRef
19.
go back to reference Misra D, Zhu Y, Zhang Y, Choi HK. The Independent impact of Congestive Heart Failure status and diuretic use on serum uric acid among men with a high cardiovascular risk profile: a prospective longitudinal study. Semin Arthritis Rheum. 2011;41(3):471–6.PubMedPubMedCentralCrossRef Misra D, Zhu Y, Zhang Y, Choi HK. The Independent impact of Congestive Heart Failure status and diuretic use on serum uric acid among men with a high cardiovascular risk profile: a prospective longitudinal study. Semin Arthritis Rheum. 2011;41(3):471–6.PubMedPubMedCentralCrossRef
20.
go back to reference Khan A, Shah MH, Khan S, Shamim U, Arshad S. Serum uric acid level in the severity of Congestive Heart Failure (CHF). Pak J Med Sci. 2017;33(2):330–4.PubMedPubMedCentralCrossRef Khan A, Shah MH, Khan S, Shamim U, Arshad S. Serum uric acid level in the severity of Congestive Heart Failure (CHF). Pak J Med Sci. 2017;33(2):330–4.PubMedPubMedCentralCrossRef
21.
go back to reference Yao Y, Zhang J, Zhang Y, Zhang R. Can Torsemide and Combination of Loop Diuretics improve mortality in patients with chronic Heart Failure after discharge? Int Heart J. 2018;59(4):813–20.PubMedCrossRef Yao Y, Zhang J, Zhang Y, Zhang R. Can Torsemide and Combination of Loop Diuretics improve mortality in patients with chronic Heart Failure after discharge? Int Heart J. 2018;59(4):813–20.PubMedCrossRef
22.
go back to reference Zhou HB, Xu TY, Liu SR, Bai YJ, Huang XF, Zhan Q, et al. Association of serum uric acid change with mortality, renal function and diuretic dose administered in treatment of acute Heart Failure. Nutr Metab Cardiovasc Dis. 2019;29(4):351–9.PubMedCrossRef Zhou HB, Xu TY, Liu SR, Bai YJ, Huang XF, Zhan Q, et al. Association of serum uric acid change with mortality, renal function and diuretic dose administered in treatment of acute Heart Failure. Nutr Metab Cardiovasc Dis. 2019;29(4):351–9.PubMedCrossRef
23.
go back to reference Yusuf S, Thom T, Abbott RD. Changes in Hypertension treatment and in Congestive Heart Failure mortality in the United States. Hypertension. 1989;13(5 Suppl):I74–9.PubMed Yusuf S, Thom T, Abbott RD. Changes in Hypertension treatment and in Congestive Heart Failure mortality in the United States. Hypertension. 1989;13(5 Suppl):I74–9.PubMed
24.
go back to reference McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of Congestive Heart Failure: the Framingham study. N Engl J Med. 1971;285(26):1441–6.PubMedCrossRef McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of Congestive Heart Failure: the Framingham study. N Engl J Med. 1971;285(26):1441–6.PubMedCrossRef
25.
go back to reference Doehner W, Anker SD, Butler J, Zannad F, Filippatos G, Ferreira JP, et al. Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in Heart Failure with reduced ejection fraction: the EMPEROR-reduced trial. Eur Heart J. 2022;43(36):3435–46.PubMedPubMedCentralCrossRef Doehner W, Anker SD, Butler J, Zannad F, Filippatos G, Ferreira JP, et al. Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in Heart Failure with reduced ejection fraction: the EMPEROR-reduced trial. Eur Heart J. 2022;43(36):3435–46.PubMedPubMedCentralCrossRef
26.
go back to reference Sakai H, Tsutamoto T, Tsutsui T, Tanaka T, Ishikawa C, Horie M. Serum level of uric acid, partly secreted from the failing heart, is a prognostic marker in patients with Congestive Heart Failure. Circ J. 2006;70(8):1006–11.PubMedCrossRef Sakai H, Tsutamoto T, Tsutsui T, Tanaka T, Ishikawa C, Horie M. Serum level of uric acid, partly secreted from the failing heart, is a prognostic marker in patients with Congestive Heart Failure. Circ J. 2006;70(8):1006–11.PubMedCrossRef
27.
go back to reference Boueiz A, Damarla M, Hassoun PM. Xanthine oxidoreductase in respiratory and cardiovascular disorders. Am J Physiol Lung Cell Mol Physiol. 2008;294(5):L830–40.PubMedCrossRef Boueiz A, Damarla M, Hassoun PM. Xanthine oxidoreductase in respiratory and cardiovascular disorders. Am J Physiol Lung Cell Mol Physiol. 2008;294(5):L830–40.PubMedCrossRef
28.
go back to reference Berry CE, Hare JM. Xanthine oxidoreductase and Cardiovascular Disease: molecular mechanisms and pathophysiological implications. J Physiol. 2004;555(Pt 3):589–606.PubMedCrossRef Berry CE, Hare JM. Xanthine oxidoreductase and Cardiovascular Disease: molecular mechanisms and pathophysiological implications. J Physiol. 2004;555(Pt 3):589–606.PubMedCrossRef
29.
go back to reference Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human Cardiovascular Disease. Heart. 2013;99(11):759–66.PubMedCrossRef Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human Cardiovascular Disease. Heart. 2013;99(11):759–66.PubMedCrossRef
30.
go back to reference Miao L, Guo M, Pan D, Chen P, Chen Z, Gao J, et al. Serum uric acid and risk of Chronic Heart Failure: a systematic review and Meta-analysis. Front Med (Lausanne). 2021;8:785327.PubMedCrossRef Miao L, Guo M, Pan D, Chen P, Chen Z, Gao J, et al. Serum uric acid and risk of Chronic Heart Failure: a systematic review and Meta-analysis. Front Med (Lausanne). 2021;8:785327.PubMedCrossRef
31.
go back to reference Okazaki H, Shirakabe A, Kobayashi N, Hata N, Shinada T, Matsushita M, et al. The prognostic impact of uric acid in patients with severely decompensated acute Heart Failure. J Cardiol. 2016;68(5):384–91.PubMedCrossRef Okazaki H, Shirakabe A, Kobayashi N, Hata N, Shinada T, Matsushita M, et al. The prognostic impact of uric acid in patients with severely decompensated acute Heart Failure. J Cardiol. 2016;68(5):384–91.PubMedCrossRef
32.
go back to reference Maloberti A, Bombelli M, Facchetti R, Barbagallo CM, Bernardino B, Rosei EA, et al. Relationships between diuretic-related hyperuricemia and cardiovascular events: data from the URic acid right for heArt Health study. J Hypertens. 2021;39(2):333–40.PubMedCrossRef Maloberti A, Bombelli M, Facchetti R, Barbagallo CM, Bernardino B, Rosei EA, et al. Relationships between diuretic-related hyperuricemia and cardiovascular events: data from the URic acid right for heArt Health study. J Hypertens. 2021;39(2):333–40.PubMedCrossRef
33.
go back to reference Rebora P, Centola M, Morici N, Sacco A, Occhino G, Viola G, et al. Uric acid associated with acute Heart Failure presentation in Acute Coronary Syndrome patients. Eur J Intern Med. 2022;99:30–7.PubMedCrossRef Rebora P, Centola M, Morici N, Sacco A, Occhino G, Viola G, et al. Uric acid associated with acute Heart Failure presentation in Acute Coronary Syndrome patients. Eur J Intern Med. 2022;99:30–7.PubMedCrossRef
34.
go back to reference Vasavada N, Agarwal R. Role of excess volume in the pathophysiology of Hypertension in chronic Kidney Disease. Kidney Int. 2003;64(5):1772–9.PubMedCrossRef Vasavada N, Agarwal R. Role of excess volume in the pathophysiology of Hypertension in chronic Kidney Disease. Kidney Int. 2003;64(5):1772–9.PubMedCrossRef
35.
go back to reference Yancy CW, Fonarow GC. Quality of care and outcomes in acute decompensated Heart Failure: the ADHERE Registry. Curr Heart Fail Rep. 2004;1(3):121–8.PubMedCrossRef Yancy CW, Fonarow GC. Quality of care and outcomes in acute decompensated Heart Failure: the ADHERE Registry. Curr Heart Fail Rep. 2004;1(3):121–8.PubMedCrossRef
36.
go back to reference Blázquez-Bermejo Z, Farré N, Llagostera M, Caravaca Perez P, Morán-Fernández L, Fort A, et al. The development of chronic diuretic resistance can be predicted during a Heart-Failure hospitalization. Results from the REDIHF registry. PLoS ONE. 2020;15(10):e0240098.PubMedPubMedCentralCrossRef Blázquez-Bermejo Z, Farré N, Llagostera M, Caravaca Perez P, Morán-Fernández L, Fort A, et al. The development of chronic diuretic resistance can be predicted during a Heart-Failure hospitalization. Results from the REDIHF registry. PLoS ONE. 2020;15(10):e0240098.PubMedPubMedCentralCrossRef
37.
go back to reference Yamamoto H, Nagatomo Y, Mahara K, Yoshikawa T. In-Hospital serum uric acid change predicts adverse outcome in patients with Heart Failure. J Card Fail. 2020;26(11):968–76.PubMedCrossRef Yamamoto H, Nagatomo Y, Mahara K, Yoshikawa T. In-Hospital serum uric acid change predicts adverse outcome in patients with Heart Failure. J Card Fail. 2020;26(11):968–76.PubMedCrossRef
38.
go back to reference Carlsen JE, Køber L, Torp-Pedersen C, Johansen P. Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. BMJ. 1990;300(6730):975–8.PubMedPubMedCentralCrossRef Carlsen JE, Køber L, Torp-Pedersen C, Johansen P. Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. BMJ. 1990;300(6730):975–8.PubMedPubMedCentralCrossRef
39.
go back to reference Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, et al. Is there a pathogenetic role for uric acid in Hypertension and cardiovascular and renal Disease? Hypertension. 2003;41(6):1183–90.PubMedCrossRef Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, et al. Is there a pathogenetic role for uric acid in Hypertension and cardiovascular and renal Disease? Hypertension. 2003;41(6):1183–90.PubMedCrossRef
40.
go back to reference Loenen HM, Eshuis H, Löwik MR, Schouten EG, Hulshof KF, Odink J, et al. Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch Nutrition Surveillance System). J Clin Epidemiol. 1990;43(12):1297–303.PubMedCrossRef Loenen HM, Eshuis H, Löwik MR, Schouten EG, Hulshof KF, Odink J, et al. Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch Nutrition Surveillance System). J Clin Epidemiol. 1990;43(12):1297–303.PubMedCrossRef
41.
go back to reference Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B, et al. Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of Heart Failure with reduced ejection fraction: findings from the EVEREST trial. Eur Heart J. 2013;34(11):835–43.PubMedCrossRef Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B, et al. Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of Heart Failure with reduced ejection fraction: findings from the EVEREST trial. Eur Heart J. 2013;34(11):835–43.PubMedCrossRef
Metadata
Title
Could admission level of uric acid predict total diuretic dose in acute heart failure?
Authors
Maryam Chenaghlou
Fatemeh Abedi mahzoon
Sina Hamzehzadeh
Ali Norouzi
Hadi Sahrai
Nasibeh Mohammadi
Negin Khadem haghighi
Mirsaeed Abdollahi
Mohammadreza Taban Sadeghi
Erfan Banisefid
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2024
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-023-03687-w

Other articles of this Issue 1/2024

BMC Cardiovascular Disorders 1/2024 Go to the issue