Division of Nephrology, Mount Sinai School of Medicine, New York, NY, USA.
Am J Med. 2012 Mar;125(3):302.e9-17. doi: 10.1016/j.amjmed.2011.06.021.
Uric acid has been proposed to play a role in acute kidney injury. We therefore investigated the potential influence of preoperative serum uric acid (SUA) on acute kidney injury in patients undergoing cardiovascular (CV) surgery. The primary aims were to investigate the incidence of acute kidney injury, peak serum creatinine (SCr) concentrations, hospital length of stay, and days on mechanical ventilation.
Retrospective study included patients who underwent CV surgery and had preoperative SUA available. Acute kidney injury was defined as an absolute increase in SCr ≥0.3 mg/dL from baseline within 48 hours after surgery. Univariate and multivariate logistic regression analysis was performed to determine the odds ratio for acute kidney injury.
There were 190 patients included for analysis. SUA were divided into deciles. The incidences of acute kidney injury were higher with higher deciles of SUA. When the incidences of acute kidney injury were plotted against all available values of SUA at increments of 0.5 mg/dL, a J-shaped curve emerged demonstrating higher incidences of acute kidney injury associated with both hypo- and hyperuricemia. In the univariate analysis, SUA ≥5.5 mg/dL was associated with a 4-fold (odds ratio [OR] 4.4; 95% confidence interval [CI], 2.4-8.2), SUA ≥6 mg/dL with a 6-fold (OR 5.9; 95% CI, 3.2-11.3), SUA ≥6.5 mg/dL with an 8-fold (OR 7.9; 95% CI, 3.9-15.8), and SUA ≥7 mg/dL with a 40-fold (OR 39.1; 95% CI, 11.6-131.8) increased risk for acute kidney injury. In the multivariate analysis, SUA ≥7 mg/dL also was associated with a 35-fold (OR 35.4; 95% CI, 9.7-128.7) increased risk for acute kidney injury. The 48-hour postoperative and hospital-stay mean peak SCr levels also were higher in the SUA ≥5.5 mg/dL group compared with the SUA <5 mg/dL group. SUA ≥7 mg/dL was associated with increased length of hospital stay (SUA <7 mg/dL, 18.5 ± 1.8 days vs SUA ≥7 mg/dL, 32.0 ± 6.8 days, P = 0.058) and a longer duration of mechanical ventilation support (SUA <7 mg/dL, 2.4 ± 0.4 days vs SUA ≥7 mg/dL, 20.4 ± 4.5 days, P = 0.001).
Preoperative SUA was associated with increased incidence and risk for acute kidney injury, higher postoperative SCr values, and longer hospital length of stay and duration of mechanical ventilation support in patients undergoing cardiac surgery. A J-shaped relationship appears to exist between SUA and acute kidney injury.
尿酸被认为在急性肾损伤中起作用。因此，我们研究了术前血清尿酸（SUA）对接受心血管（CV）手术患者急性肾损伤的潜在影响。主要目的是调查急性肾损伤的发生率、血清肌酐（SCr）峰值浓度、住院时间和机械通气时间。
回顾性研究纳入了接受 CV 手术且术前有 SUA 检测值的患者。急性肾损伤定义为术后 48 小时内 SCr 绝对值较基线升高≥0.3mg/dL。采用单变量和多变量逻辑回归分析确定急性肾损伤的比值比。
共纳入 190 例患者进行分析。SUA 分为十分位数。随着 SUA 十分位数的升高，急性肾损伤的发生率也升高。当急性肾损伤的发生率与所有可用的 SUA 值进行比较时，在增量为 0.5mg/dL 的情况下，出现了一个 J 形曲线，表明低尿酸血症和高尿酸血症都与更高的急性肾损伤发生率相关。在单变量分析中，SUA≥5.5mg/dL 与 4 倍（比值比[OR]4.4；95%置信区间[CI]2.4-8.2）、SUA≥6mg/dL 与 6 倍（OR 5.9；95%CI 3.2-11.3）、SUA≥6.5mg/dL 与 8 倍（OR 7.9；95%CI 3.9-15.8）、SUA≥7mg/dL 与 40 倍（OR 39.1；95%CI 11.6-131.8）的急性肾损伤风险增加相关。在多变量分析中，SUA≥7mg/dL 也与急性肾损伤风险增加 35 倍（OR 35.4；95%CI 9.7-128.7）相关。SUA≥5.5mg/dL 组的 48 小时术后和住院期间平均 SCr 峰值也高于 SUA<5mg/dL 组。SUA≥7mg/dL 与住院时间延长（SUA<7mg/dL，18.5±1.8 天 vs SUA≥7mg/dL，32.0±6.8 天，P=0.058）和机械通气时间延长（SUA<7mg/dL，2.4±0.4 天 vs SUA≥7mg/dL，20.4±4.5 天，P=0.001）相关。
术前 SUA 与接受心脏手术患者的急性肾损伤发生率和风险增加、术后 SCr 值升高、住院时间延长和机械通气支持时间延长相关。SUA 与急性肾损伤之间似乎存在 J 形关系。
