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Uric acid elevation in pediatric patients with dilated cardiomyopathy and prediction of mortality
Yong Han1, Cheng Chen1, Suyuan Qin1
1Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Insights
Elevated serum uric acid (SUA) levels predict mortality in children with dilated cardiomyopathy (DCM). Higher SUA levels significantly increase the risk of death, especially in younger children.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Biomarker Discovery
Background:
- Pediatric dilated cardiomyopathy (DCM) is a leading cause of heart failure in children.
- Effective prognostic markers are urgently needed for risk stratification and management.
Purpose of the Study:
- To investigate the association between serum uric acid (SUA) levels and mortality in children with DCM.
- To determine if SUA can serve as a prognostic biomarker in this population.
Main Methods:
- A retrospective study of 145 children diagnosed with DCM.
- Analysis of serum uric acid (SUA) levels and all-cause mortality.
- Kaplan-Meier curves, multivariate Cox models, and restricted cubic spline (RCS) models were used.
Main Results:
- Elevated SUA levels were significantly associated with increased 1-year and overall mortality in pediatric DCM.
- The highest SUA tertile showed a substantially greater risk of mortality.
- Age modified the association, with a linear relationship in children ≤10 years and a U-shaped relationship in those >10 years.
Conclusions:
- Serum uric acid (SUA) is a significant predictor of mortality in pediatric DCM.
- SUA levels may be valuable biomarkers for risk stratification in pediatric DCM patients.
- Age is a critical factor influencing the prognostic value of SUA.
Background And Aims:
Pediatric dilated cardiomyopathy (DCM) is a primary cause of heart failure, highlighting the urgent need for effective prognostic markers.
Methods:
We performed a single-center retrospective study involving 145 children diagnosed with DCM, with a median follow-up period of 4.0 months (interquartile range: 6.2-108.4 months). The relationship between serum uric acid (SUA) levels and all-cause mortality was assessed using Kaplan-Meier survival curves, multivariate Cox proportional hazard models, and restricted cubic spline (RCS) models.
Results:
Of the 145 children with DCM (median age 5.7 years; 61.4% male), 45 (31%) died within 1 year, and 65 (44.8%) died during the maximum follow-up period. In adjusted multivariate Cox regression models, each log2 SUA increase was linked to a higher risk of 1-year mortality [hazard ratio (HR), 2.66; 95% confidence interval (CI), 1.41-5.01] and overall mortality (HR, 1.97; 95% CI, 1.15-3.37). The highest SUA tertile showed a greater risk of mortality at 1 year (HR, 4.26; 95% CI: 1.5-12.06) and during the maximum follow-up (HR, 2.56; 95% CI: 1.06-6.16) compared with the lowest tertile. RCS models indicated an inverted L-shaped association between baseline SUA levels and overall mortality risk, with age-stratified analyses revealing a linear and U-shaped relationship in children ≤10 and >10 years, respectively. Further age-stratified analyses highlighted the modifying effect of age on this association.
Conclusion:
Elevated SUA levels are a significant predictor of mortality in pediatric DCM, with a pronounced impact on children under 10 years of age. Therefore, SUA levels could serve as potential biomarkers for risk stratification in this population.
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