High uric acid variability was associated with increased all-cause mortality (HR 1.58; 95% CI 1.51-1.69; p<0.001) compared to moderate variability in patients with heart failure.
Cohort (n=18,115)
Does serum uric acid variability predict all-cause mortality and heart failure hospitalization in patients with heart failure?
Intra-individual serum uric acid variability is a strong, independent predictor of all-cause mortality and heart failure hospitalization in patients with heart failure.
Effect estimate: HR 1.58 (95% CI 1.51-1.69)
p-value: p=< 0.001
Aims: Elevated uric acid (UA) levels correlate with worse heart failure (HF) outcomes, but past studies used single UA measurements. The effect of intra-individual UA fluctuations, beyond mean levels, is unclear. This study assesses the relationship between serum UA variability and adverse clinical outcomes in HF patients. Methods: We analyzed 18,115 HF patients from the SHEBAHEART registry (2009–2025) with at least three UA measurements within three years of diagnosis. UA variability was quantified as the mean deviation (MD) from each patient’s average UA level and divided into quartiles: Q1 (≤−0.69 mg/dL), Q2–Q3 (>−0.69 and <1.53 mg/dL, reference), and Q4 (≥1.53 mg/dL). All-cause mortality was the primary outcome and HF hospitalization was secondary. Cox regression, propensity score matching, and subgroup analyses were used. Results: Over a median follow-up of 4.3 years (IQR 1.6–7.7), 36% of patients were hospitalized for HF and 65.5% died. UA variability showed a graded association with outcomes. Low variability (Q1) was linked to reduced mortality (HR 0.79, 95% CI 0.75–0.83) and HF hospitalization (HR 0.84, 95% CI 0.79–0.90), while high variability (Q4) increased mortality (HR 1.58, 95% CI 1.51–1.69) and hospitalization risk (HR 1.17, 95% CI 1.10–1.25) (all p < 0.001). These associations remained after propensity score matching and across HF subgroups. Conclusions: UA variability is a robust, independent predictor of mortality and HF hospitalization. Serial UA monitoring may enhance risk stratification in HF management.
Copeland et al. (Wed,) conducted a cohort in Heart failure (n=18,115). High uric acid variability (Q4) vs. Moderate uric acid variability (Q2-Q3) was evaluated on All-cause mortality (HR 1.58, 95% CI 1.51-1.69, p=< 0.001). High uric acid variability was associated with increased all-cause mortality (HR 1.58; 95% CI 1.51-1.69; p<0.001) compared to moderate variability in patients with heart failure.