Association of serum uric acid change with mortality, renal function and diuretic dose administered in treatment of acute heart failure

BACKGROUND AND AIMS

Hyperuricemia is reportedly associated with poor outcome in acute heart failure (AHF). The association between changes in Uric acid (UA) levels with renal function change, diuretic doses, and mortality in patients with AHF were studied.

METHODS AND RESULTS

Consecutive patients hospitalized with AHF were reviewed (n = 535). UA levels were measured at admission and either at discharge or on approximately the seventh day of admission. Patients with an UA change in the top tertile were defined as having an increase (UA-increase) and were compared to those outside the top tertile (non-UA-increase). The endpoint was all-cause mortality, with a mean follow-up duration of 22.2 months. Patients in the UA-increase group presented with greater creatine increase (P < 0.001), and were administered a higher average daily dose of loop diuretic (P = 0.016) compared with the non-UA-increase group. In-hospital UA-increase was associated with higher risk of mortality even after adjusting for confounding variables including creatine change and diuretic dosage [harzard ratio (HR) 1.53, 95% confidence interval (CI) 1.02-2.30, P = 0.042]. In patients with hyperuricemia on admission, UA-increase was associated with increased mortality (adjusted HR 2.21, 95% CI 1.38-3.52, P = 0.001). Whereas, in those without admission hyperuricemia, UA-increase had no significant association with mortality.

CONCLUSIONS

An increase in UA during in-hospital treatment is associated with an increase in creatine levels and daily diuretic dose. Mortality associated with increased UA is restricted to patients who already have hyperuricemia at admission. A combination of UA levels at admission and UA changes on serial assessment during hospitalization may be additional value in the risk stratification of AHF patients.

[A retrospective analysis of clinical characteristics and outcomes of heart failure patients with different left ventricular ejection fractions]

Objective: To compare the clinical characteristics, and outcomes of patients with heart failure with different left ventricular ejection fractions (LVEF). Methods: A total of 1 182 hospitalized patients with heart failure (HF) were enrolled and retrospectively studied in the present study. The patients were stratified by LVEF as reduced (HFrEF, LVEF<40%, n=313), mid-range (HFmrEF, 40% ≤LVEF <50%, n=287) and preserved (HFpEF, LVEF≥50%, n=582) ejection fraction groups. Among the 1 182 cases, 941 of them (81.3%, 84.9%, and 84.0% inHFrEF, HFmrEF and HFpEF groups, respectively) were followed up for an median duration of 27.3 months. Results: (1) Among the study patients, 26.5% were in HFrEF, 24.3% in HFmrEF, and 49.2% in HFpEF groups. (2) Ischemic heart disease with HFmrEF was more frequent than that in patients with HFrEF. The average age, percentage of female subjects, systolic blood pressure, uric acid, N terminal B-type natriuretic peptide precursor (NT-proBNP), hemoglobin, and the incidence of hypertensive heart disease, anemia, atrial fibrillation in patients with HFmrEF were higher than those in patients with HFrEF, but lower than those in patients with HFpEF (all P<0.01). (3) The all-cause cumulative mortality was 10.8% at 1 year, 20.6% at 2 years and 35.9% at 5 years. No difference was observed in the all-cause cumulative mortality at 1 year, 2 years, 5 years among the three groups (all P>0.05). Conclusions: The HFmrEF patients, as a new and distinct group, were with many intermediate characteristics compared with HFrEF and HFpEF subjects. However, the all-cause mortality was not significantly different among HF patients with different LVEF.

The association of new inflammatory markers with type 2 diabetes mellitus and macrovascular complications: a preliminary study

AIM

Type 2 diabetes mellitus (T2DM) is not simply a disease of hyperglycemia, but also is an inflammatory disorder. This study aimed to observe the expression of inflammation-related factors in elderly T2DM patients with or without macrovascular disease (MVD).

PATIENTS AND METHODS

A total of 64 T2DM patients participated in this study, including 31 patients with MVD (group A) and 33 patients without MVD (group B); and 30 healthy volunteers were recruited as normal control (group C). The levels of serum irisin, retinol-binding protein 4 (RBP4) and adiponectin expression were all detected and compared between groups.

RESULTS

The demographic and clinical characteristics were comparable between T2DM patients and healthy volunteers. For patients in group A, the serum levels of irisin, RBP4 and adiponectin were 12.05 ± 2.12 pg/mL, 2.13 ± 0.83 µg/mL and 45.65±20.13 ng/mL, respectively. While the corresponding parameters were 26.11 ± 4.09 pg/ml, 1.54 ± 0.54 µg/ml and 57.93 ± 23.47 ng/mL for patients in group B; and were 40.25 ± 2.73 pg/mL, 0.98 ± 0.36 µg/mL and 60.03 ± 20.26 ng/mL for healthy volunteers in group C, respectively. As compared to healthy volunteers, the levels of irisin, RBP4 and adiponectin were all significantly changed in T2DM patients; and the difference in irisin, RBP4 and adiponectin between T2DM patients with and without MVD were all significant (p = 0.000, p = 0.001, and p = 0.029, respectively). Multivariate regression analysis showed that irisin and RBP4 are both independent predictors for MVD in T2DM patients.

CONCLUSIONS

Inflammatory disorder is significantly in T2DM patients with MVD, and serum irisin and RBP4 would be reasonable new markers of MVD.

The effect of green tea extract on the removal of sulfur-containing oral malodor volatiles in vitro and its potential application in chewing gum

Increasing pH solution from 7.5 to 8.0 was found to significantly improve the effectiveness of green tea extract for methanethiol removal in vitro. Green tea extract was also found to remove hydrogen sulfide and its effectiveness was greatly improved under alkaline conditions. It was found that with green tea extract, maximum H₂S removal was achieved when the pH was between 8.1 and 8.4 at 37 °C for 5 min. Further increases in pH resulted in decrease of the extract effectiveness. Vegetable acetone powders which contain polyphenol oxidases or peroxidases were found to further enhance the effectiveness for the removal of thiols when used in combination with green tea extracts at body temperature under alkaline conditions. Adding 5% baking soda to green tea extract-containing chewing gum was found to buffer saliva pHs to 8.0 during 10 min of chewing. However, severe discoloration was observed and undesirable bitterness was perceived, most likely due to the polymerization of unencapsulated green tea polyphenols. Therefore, encapsulation of green tea extract is recommended for applications at elevated pHs.