Background:
Although hyperuricemia is common, it is thought that gouty arthritis is rare in adult patients (pts) with cyanotic congenital heart disease (CCHD). However, the actual frequency of hyperuricemia and gout has not been documented. Furthermore, whether hyperuricemia should be treated remains undetermined. This study investigated
the incidence of hyperuricemia and gout,
risk factors for hyperuricemia and gout, and
whether the use of allopurinol decreases the incidence of gout in adult patients with CCHD.
Methods:
We studied 92 pts with CCHD, including 19 pts with Eisenmenger syndrome (mean age: 33±11 years of age, ranging from 15 to 61), M/F = 48/44) (CCHD group). Comparative data was obtained from 210 acyanotic CHD pts after biventricular repair (mean age: 31±11 years, ranging from 15 to 83, M/F = 98/112) (ACHD group). Hyperuricemia was defined as serum uric acid (UA) > 7.0mg/dl. The risk factors studied were: age, gender, RBC counts, hemoglobin, hematocrit, oxygen saturation, serum creatinine, glomerular filtration rate, cardiothoracic ratio, brain natriuretic peptide and medications, including diuretics, beta-blocker and aspirin.
Results:
Prevalence of hyperuricemia was 76% in the CCHD group and 24% in the ACHD group. Logistic regression analysis demonstrated that variables that significantly influence hyperuricemia were; hemoglobin over 18g/dl (odds ratio 6.2), oxygen saturation less than 90 (OR 4.8), the use of diuretics (OR 4.0), and serum creatinine higher than 1.0 mg/dl (OR 2.0). Gouty arthritis was observed in 16% in the CCHD group and only 1% in the ACHD group. The prevalence of hyperuricemia and gout in the CCHD group was significantly higher than that in the ACHD group. Of 92 pts in the CCHD group, allopurinol was administered to 37 pts for gout prophylaxis. Of 55 pts without allopurinol, 13 (24%) suffered from gout. In contrast, only 2 of 37 pts (5%) on allopurinol developed gout and the incidence was significantly lower than that in pts without allopurinol.
Conclusion:
These data suggest that in adult patients with CCHD,
the incidence of gout is high,
desaturation, polycytemia, impaired renal function, and the use of diuretics are risk factors for hyperuricemia and gout, and
hyperuricemia should be treated with medication.
Cardiopulmonary exercise testing predicts death and hospitalisation in adult patients with cyanotic congenital heart disease
