Serum Ürik Asit Düzeyinin Kardiyak Disfonksiyonda Prognostik bir Önemi Var mıdır?

Öz

Amaç: Ürik asit, pürin metabolizmasının son ürünü ve gut için iyi bilinen bir risk faktörüdür. Bununla birlikte, yüksek serum ürik asit düzeyleri insülin rezistansı, obezite, hipertansiyon, renal disfonksiyon, hipotiroidi gibi birçok hastalıkla ilişkili bulunmuştur. Öte yandan, ürik asidin kardiyovasküler morbiditede nedensel bir rol oynayıp oynamadığı tartışılmaktadır. Çalışmamızda serum ürik asit (ÜA) ve kalp yetmezliği prognostik belirteci olan N terminal pro B-tipi Natriüretik Peptit (NT-proBNP) düzeyleri ile sol ventrikül fonksiyon bozukluğu arasında ilişki olup olmadığını araştırmayı amaçladık.
Materyal ve Metot: Çalışma retrospektif olarak planlandı. Mart 2016 ile Şubat 2017 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi Kardiyoloji Servisi ve Koroner Yoğun Bakımda yatan 326 hasta çalışmaya dahil edildi. Bu hastaların serum ÜA, NT-proBNP düzeyleri ile ejeksiyon fraksiyonu (EF) bulguları hastane enformasyon sisteminden alındı. Hastalar serum ÜA düzeylerine göre 4 gruba ayrıldı (1. grup ÜA; 2,7-4,9 mg/dL, 2. grup ÜA; 5-6 mg/dL, 3. grup ÜA; 6,1-7,4 mg/dL, 4. grup ÜA; 7,5-15,6 mg/dL). Gruplar arasında parametreler ANOVA testi kullanılarak karşılaştırıldı. Ayrıca, sol ventrikül disfonksiyon bulgularında ürat düzeylerine göre değişimler incelenirken, cinsiyet, yaş ve eGFR ‘nin bu parametreler üzerindeki etkileri değerlendirildi. Değişkenler arasında ilişki için Pearson korelasyon testi kullanıldı.
Bulgular: 4. grup; yaş, NT-proBNP, eGFR diğer gruplardan anlamlı düzeyde farklıydı (p<0.001). EF, 4. grup ile 1. ve 3. gruplar arasında anlamlı farklı bulundu (sırası ile p=0,006 and p=0,002). Ancak EF’nun gruplar arasındaki farklılıkları üzerinde yaş ve eGFR etkisinin olmadığı görüldü. Gruplardan bağımsız olarak serum ÜA düzeyi ile NT-proBNP arasında istatistiksel olarak anlamlı ancak zayıf pozitif korelasyon (r=0,310, p<0,001), % LVEF arasında ise düşük düzeyde ancak anlamlı negatif korelasyon (r=-0,173, p=0,002) tespit edildi.

Sonuç: Çalışmamızdaki bulgulara göre serum ÜA düzeyinin kardiyak disfonksiyonda prognostik öneme sahip olduğu ve hastaların takibinde kullanılabileceği kanısına varılmıştır.

Anahtar Kelimeler

• Kardiyak disfonksiyon,NT-proBNP,ürik asit

Is There a Prognostic Significance of Serum Uric Acid Levels in Cardiac Dysfunction?

Abstract

Objectives: Uric acid (UA) is the end-product of purine metabolism and is a well-known risk factor for gout disease. In addition to that, elevated serum UA levels have been associated with many disorders including insulin resistance, obesity, hypertension, renal dysfunction and hypothyroidism. On the other hand, whether uric acid has any causal relationship with cardiovascular morbidity is a debated issue.

Materials and Methods: This retrospective study included totally 326 patients who were inpatients at the Cardiology Ward or Coronary Intensive Care Unit of Ankara Numune Training and Research Hospital between March 2016 and February 2017. Data regarding serum UA and N-terminal pro B-type Natriuretic Peptide (NT-proBNP) levels and left ventricular ejection fraction %) LVEF) were retrieved from the hospital information system. Patients were categorized into four groups based on their UA levels (Group 1 UA: 2.7-4.9 mg/dL, Group 2 UA: 5-6 mg/dL, Group 3 UA: 6.1-7.4 mg/dL, Group 4 UA: 7.5-15.6 mg/dL). Other parameters were compared between the groups using ANOVA test. Additionally, the effects of gender, age and eGFR were also examined when evaluating the changes in left ventricular function according to UA levels. Correlation between the variables was analyzed with Pearson’s correlation test.

Results: Group 4 was significantly different than the rest of the groups in terms of age, NT-proBNP and eGFR (p<0.001). In addition, group 4 showed significant difference from Group 1 and Group 3 regarding %LVEF (p=0.006 and p=0.002, respectively). However, the differences between the groups regarding %LVEF was not influenced by age or eGFR. Regardless of the groups, serum UA levels showed statistically significant but weak positive correlation with NT-proBNP (r=0.310, p<0.001), and low level of negative correlation with % LVEF, which was statistically significant (r=-0.173, p=0.002).

Conclusion: Based on our findings, we concluded that serum UA level has prognostic significance in cardiac dysfunction and can be used in the follow-up of such patients.

Keywords

• Cardiac dysfunction,NT-proBNP,uric acid

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