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Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome

  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Marco Centola
    Correspondence
    Corresponding author at: Division of Cardiology, Cardio-Respiratory Department, ASST Santi Paolo Carlo, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy.
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Alessandro Maloberti
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Cardiology IV, ASST GOM Niguarda, Milan, Italy

    School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Diego Castini
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Simone Persampieri
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Ludovico Sabatelli
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Giulia Ferrante
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Stefano Lucreziotti
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Nuccia Morici
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Cardiology I, ASST GOM Niguarda, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Alice Sacco
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    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Cardiology I, ASST GOM Niguarda, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Fabrizio Oliva
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Cardiology I, ASST GOM Niguarda, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Paola Rebora
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Cristina Giannattasio
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Cardiology IV, ASST GOM Niguarda, Milan, Italy

    School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Antonio Mafrici
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Stefano Carugo
    Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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  • Author Footnotes
    1 All the authors take responsability for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

      Highlights

      • The relationship between baseline levels of SUA and cardiovascular diseases is not fully elucidated.
      • The levels of SUA were significantly higher in male compared to women, in the elderly (>75 years old), in patients with diabetes, with hypertension, with CKD, with NSTE-ACS, with AKIN during hospitalization and in patients who died.
      • The rates of AKIN, implantation of IABP and NIV use were significantly higher in patients in high levels of SUA.
      • High admission levels of SUA are positively and independently associated with in-hospital adverse outcomes and mortality.
      • The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality.

      Abstract

      Background

      To assess the association between admission serum uric acid (SUA) levels and in-hospital outcomes in a real-world patients population with acute coronary syndrome (ACS) and to investigate the potential incremental prognostic value of SUA added to GRACE score (GRACE-SUA score).

      Methods

      The data of consecutive ACS patients admitted to Coronary Care Unit of San Paolo and Niguarda hospitals in Milan (Italy) were retrospectively analyzed.

      Results

      1088 patients (24% female) were enrolled. Mean age was 68 years (IQR 60–78). STEMI and NSTE-ACS patients were 504 (46%) and 584 (54%) respectively. SUA (OR 1.72 95%CI 1.33–2.22, p < 0.0001) and GRACE score (OR 1.04 95%CI 1.02–1.06, p < 0.0001) were significantly associated with an increased risk of in-hospital death at the multivariate analysis. Admission values of SUA were stratified in four quartiles. Rates of acute kidney injury, implantation of intra-aortic balloon pump and non-invasive ventilation use were significantly higher in the last quartile compared to Q1, Q2 and Q3 (p < 0.01). The areas under the ROC curve (AUC) for GRACE score and for SUA were 0.91 (95% CI 0.89–0.93, p < 0.0001) and 0.79 (95% CI 0.76–0.81, p < 0.0001) respectively. The AUC was larger for predicting in-hospital mortality with the GRACE-SUA score (0.94; 95% CI 0.93–0.95).

      Conclusions

      High admission levels of SUA are independently associated with in-hospital adverse outcomes and mortality in a contemporary population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality in this study population.

      Keywords

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