A linear association between serum uric acid and 28-day and 90-day mortality after veno-arterial extracorporeal membrane oxygenation in patients with acute myocardial infarction complicated by cardiogenic shock.

Authors

Ruike Ma, Xiaoxiao Zhou, Shang Gu, Yifeng Du, Wei Zhang, Zongwei Gao

Published in

Frontiers in cardiovascular medicine. Volume 13. Pages 1839659. Epub Jul 27, 2026.

Abstract

This study aimed to delineate the relationship between serum uric acid (UA) and 28-day and 90-day mortality among patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
In this retrospective, single-center cohort study, we consecutively enrolled 142 patients supported with VA-ECMO for AMI-CS. Baseline UA was treated as the exposure of interest, and 28-day and 90-day mortality were prespecified primary outcomes. Associations between UA and mortality were evaluated using Cox proportional-hazards models, Kaplan-Meier estimates, receiver operating characteristic curve (ROC), and restricted cubic spline (RCS) regression.
Among 142 patients, the median baseline UA level was 452.00 μmol/L (361.00-561.75 μmol/L), and 28-day and 90-day mortality were 33.8% and 40.8%, respectively. After adjustment for potential confounders, each 1 μmol/L increment in UA remained associated with higher hazards of 28-day mortality (HR: 1.002, 95% CI: 1.000-1.003; P = 0.038) and 90-day mortality (HR: 1.002, 95% CI: 1.001-1.004; P = 0.005). Per one standard-deviation increase in UA, the hazards of 28-day and 90-day mortality increased by 37.9% (HR: 1.379, 95% CI: 1.019-1.867; P = 0.038) and 49.4% (HR: 1.494, 95% CI: 1.126-1.982; P = 0.005), respectively. Relative to the low-UA group, the high-UA group exhibited substantially higher risks of both 28-day (HR: 2.499, 95% CI: 1.335-4.677; P = 0.004) and 90-day mortality (HR: 2.262, 95% CI: 1.222-4.188; P = 0.009). ROC analyses indicated a moderate discriminatory performance of UA for 28-day and 90-day mortality, with AUCs of 0.631 (95% CI: 0.532-0.729; P = 0.011) and 0.621 (95% CI: 0.527-0.714; P = 0.015), respectively. Kaplan-Meier curves demonstrated significant separation in cumulative mortality between UA strata, with worse survival in the high-UA group (log-rank P = 0.001). RCS analyses further supported a significant linear association between UA and both endpoints (P for nonlinearity >0.05).
Elevated UA was associated with increased 28-day and 90-day mortality after VA-ECMO in AMI-CS. Given the single-center, retrospective, and observational design, these findings should be interpreted cautiously and require external validation before UA can be considered for clinical risk assessment.

PMID:
42577160
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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