Aminiahidashti Hamed, Bozorgi Farzad, Mousavi Seyed Jaber, Sedighi Omid, Gorji Ali Morad Heidari, Rashidian Hale
Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
J Lab Physicians. 2017 Jan-Mar;9(1):42-46. doi: 10.4103/0974-2727.187916.
This study was conducted to evaluate the validity of serum uric acid (UA) in prediction of mortality among patients in the emergency department.
This is a prospective cohort study which was conducted during 2014. In this study, 120 critically ill patients who required Intensive Care Unit care services were included. For evaluation of severity of the disease, mortality in emergency department score (MEDS) in the first 24 h of admission, the requirement of using mechanical ventilation, taking vasopressor during the hospitalization time and severity of the disease based on MEDS score were measured. The patients were divided into two groups: Patients with serum UA level lower than 7.3 mg/dl and patients with serum UA level of equal or more than 7.3 mg/dl. For comparison of the mortality rate in groups, Chi-square and fisher exact tests were applied.
In patients, who needed mechanical ventilation, average of serum UA was 7.82 ± 2.82; however, in the patients who did not need mechanical ventilation this amount was 6.16 ± 2.7, a difference was statically significant. We found a statically meaningful difference between serum UA level with requiring mechanical ventilation and the predictive level of UA 6.95 ± 0.73 ( = 8.52; ≤ 0.004). In the evaluation of MEDS, most patients with serum UA levels lower than 7.3 mg/dl had lower MEDS points (on average 4.6 ± 3.21) in compared to patients with serum UA level higher than 7.3 mg/dl (on average 12 ± 2.99). This difference was found to be statistically significant which indicates the patients whose serum UA was 7.3 mg/dl or higher, were at higher risk of mortality.
The serum UA level in the 1 day of hospitalization of a critically ill patient is not an independent indicative factor in relation to mortality. High level of UA reveals critical status of the patient and requires mechanical ventilation.
本研究旨在评估血清尿酸（UA）在预测急诊科患者死亡率方面的有效性。
这是一项于2014年进行的前瞻性队列研究。本研究纳入了120名需要重症监护病房护理服务的危重病患者。为评估疾病严重程度，测量了入院后最初24小时内的急诊科死亡率评分（MEDS）、使用机械通气的需求、住院期间使用血管升压药的情况以及基于MEDS评分的疾病严重程度。患者被分为两组：血清UA水平低于7.3mg/dl的患者和血清UA水平等于或高于7.3mg/dl的患者。为比较两组的死亡率，应用了卡方检验和Fisher精确检验。
在需要机械通气的患者中，血清UA的平均值为7.82±2.82；然而，在不需要机械通气的患者中，这一数值为6.16±2.7，差异具有统计学意义。我们发现血清UA水平与需要机械通气之间以及UA预测水平6.95±0.73（χ² = 8.52；P≤0.004）之间存在统计学上有意义的差异。在评估MEDS时，与血清UA水平高于7.3mg/dl的患者（平均12±2.99）相比，大多数血清UA水平低于7.3mg/dl的患者MEDS评分较低（平均4.6±3.21）。发现这种差异具有统计学意义，这表明血清UA为7.3mg/dl或更高的患者死亡风险更高。
危重病患者住院第1天的血清UA水平并非与死亡率相关的独立指示因素。高水平的UA表明患者处于危急状态且需要机械通气。
