背景：血清尿酸是慢性心力衰竭预后的重要影响因素。但在急性心力衰竭患者中，血清尿酸与不良预后的相关性以及肾功能分期、心力衰竭分型和心功能分级对这种相关性的影响尚缺乏大规模临床研究的证据。

目的：评估急性心力衰竭人群中血清尿酸与不良预后的关联。

方法：基于重大慢病国家注册登记研究心衰前瞻队列开展,纳入4346名急性心力衰竭患者。主要终点事件为整个随访期间的全因死亡和心血管死亡，次要终点事件为随访1年的主要不良心血管事件及心力衰竭再入院。通过多元Cox比例风险模型评估血清尿酸与终点事件的关联以及限制性立方条样分析评其量效关系。通过引入临床指标与高尿酸血症的乘积评估其对高尿酸血症与死亡关联的修饰效应。通过比较纳入血清尿酸前后的一致性指数评估其对终点事件的预测效能。

结果：高尿酸血症显著增加急性心力衰竭患者的全因死亡（HR 1.33, 95% CI 1.20-1.46, p= 0.004）和心血管死亡风险（HR 1.35, 95% CI 1.20–1.51, p< 0.001），且这种关联不受肾功能分期、心力衰竭分型以及心功能分级的影响。高尿酸血症显著增加1年内的主要不良心血管事件（HR 1.30, 95% CI 1.15-1.48, p< 0.001）以及心力衰竭再入院风险（HR 1.31, 95% CI 1.17-1.47, p< 0.001）。血清尿酸与死亡和主要不良心血管事件之间呈“J”形关联，与心力衰竭再入院成正线性关联。血清尿酸对终点事件均具有较好的预测效能（p< 0.05）。

结论：血清尿酸与急性心力衰竭患者的不良预后呈正相关，且不受肾功能水平、心功能分级及心力衰竭分型的影响。血清尿酸可用于急性心力衰竭人群的危险分层，指导个体化治疗的开展并改善临床预后。

Background: Serum uric acid (SUA) has been proved as a significant prognostic marker in patients with chronic heart failure (CHF). However, in patients with acute heart failure (AHF), there is a lack of solid evidence on the association between SUA and adverse outcomes.

Objective: This study aims to evaluate the associations between SUA and adverse outcomes.

Methods: This study was based on the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure (China PEACE 5p-HF) cohort and enrolled 4,346 AHF patients. The primary outcomes were all-cause mortality (ACM) and cardiovascular mortality (CVM) during the entire follow-up period. The secondary outcomes were major adverse cardiovascular events (MACE) and hospitalization for heart failure (HHF) within 1-year follow-up. The multivariable Cox proportional hazards model was conducted to investigate the correlations between SUA and outcomes. The restricted cubic spline (RCS) analysis was employed to assess the linearity and dose-response relationships between SUA and outcomes. The modification effects of other clinical parameters on the association between hyperuricemia and mortality risk were assessed by incorporating multiplicative interaction terms. The predictive performances for outcomes were evaluated by comparing the concordance index (C-index) of multivariate models including SUA or not.

Results: Hyperuricemia significantly increased the risk of ACM (HR 1.33, 95% CI 1.20-1.46, p= 0.004) and CVM (HR 1.35, 95% CI 1.20–1.51, p< 0.001) in AHF patients, regardless of renal function, NYHA functional classification, and heart failure subtypes. Hyperuricemia significantly associated with an increased risk of 1-year MACE (HR 1.30, 95% CI 1.15-1.48, p< 0.001) and 1-year HHF (HR 1.31, 95% CI 1.17-1.47, p< 0.001). RCS analysis revealed a J-shaped association of SUA with both mortality and MACE, while a positive linear relationship of SUA with HHF. SUA demonstrated improved predictive performance for outcomes (p< 0.05).

Conclusions: SUA were positively associated with adverse outcomes in AHF patients, independent of renal function, NYHA functional classification, and HF subtypes. SUA may facilitate risk stratification in AHF patients, guide individualized treatment strategies, and improve clinical outcomes.