Association between high serum uric acid and poor outcomes in patients with acute heart failure

Background Heart failure remains a major worldwide problem with high prevalence in mortality and morbidity. On the other hand, hyperuricemia has been reported to be closely associated with an increased risk of cardiovascular diseases, including hypertension and heart failure. While evidence links hyperuricemia to mortality in Chronic Heart Failure, its prognostic value in acute heart failure (AHF) patients has yet to be thoroughly determined. Purpose This study aims to determine the prognostic value of high serum uric acid in predicting outcomes (deaths and rehospitalisation) of patients with acute heart failure. Methods This research is reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Systematic literature searches were performed through PubMed, Scopus, Science Direct, and EBSCOHost from inception to 22 May 2023. Studies fulfilling pre-determined eligibility criteria were qualitatively appraised using Joanna-Briggs Institute (JBI) Critical Appraisal Tools. The data was then quantitatively analysed using RevmanWeb (Cochrane). Pooled estimates of outcomes presented as hazard ratio (HR) were generated with a random-effect model and I2 was used to assess the heterogeneity across studies. Results Eleven cohort studies from six different countries were included in the qualitative analysis. The meta-analysis involved eight studies with 4,949 patients. AHF patients with hyperuricemia on admission had a higher risk of poor outcomes (death and rehospitalisation) compared to the control at any point in time. (HR: 1.37, 95% CI [1.20-1.57], p < 0.001, I2 = 54%). Conclusion High serum uric acid level has prognostic value and isassociated with poor outcomes in AHF patients. To improve patients' outcomes, further research is recommended to explore risk stratification and the most suitable treatment for hyperuricemia, especially on admission.