Wu Ming-Ju, Tsai Shang-Feng, Lee Cheng-Ting, Wu Chun-Yi
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
J Clin Med. 2019 Jul 10;8(7):1003. doi: 10.3390/jcm8071003.
The aim of this study was to determine whether elevated serum level of uric acid (sUA) could predict renal outcome after contrast-enhanced computerized tomography (CCT). We used a historical cohort of 58,106 non-dialysis adult patients who received non-ionic iso-osmolar CCT from 1 June 2008 to 31 March 2015 to evaluate the association of sUA and renal outcome. The exclusion criteria were patients with pre-existing acute kidney injury (AKI), multiple exposure, non-standard volume of contrast, and missing data for analysis. A total of 1440 patients were enrolled. Post-contrast-AKI (PC-AKI), defined by the increase in serum creatinine ≥ 0.3 mg/dL within 48 h or ≥50% within seven days after CCT, occurred in 180 (12.5%) patients and the need of hemodialysis within 30 days developed in 90 (6.3%) patients, both incidences were increased in patients with higher sUA. sUA ≥ 8.0 mg/dL was associated with an increased risk of PC-AKI (odds ratio (OR) of 2.62; 95% confidence interval (CI), 1.275.38, = 0.009) and the need of hemodialysis (OR, 5.40; 95% CI, 1.3921.04, = 0.015). Comparing with sUA < 8.0 mg/dL, patients with sUA ≥ 8.0 mg/dL had higher incidence of PC-AKI (16.7% vs. 11.1%, = 0.012) and higher incidence of hemodialysis (12.1% vs. 4.3%, < 0.001). We concluded that sUA ≥ 8.0 mg/dL is associated with worse renal outcome after CCT. We suggest that hyperuricemia may have potential as an independent risk factor for PC-AKI in patients receiving contrast-enhanced image study.
本研究的目的是确定血清尿酸（sUA）水平升高是否能预测对比增强计算机断层扫描（CCT）后的肾脏结局。我们使用了一个历史队列，该队列包含58106例非透析成年患者，他们在2008年6月1日至2015年3月31日期间接受了非离子等渗CCT，以评估sUA与肾脏结局之间的关联。排除标准为既往有急性肾损伤（AKI）、多次暴露、对比剂用量不标准以及缺少分析数据的患者。共纳入1440例患者。对比剂后急性肾损伤（PC-AKI）定义为CCT后48小时内血清肌酐升高≥0.3mg/dL或7天内升高≥50%，180例（12.5%）患者发生了PC-AKI，90例（6.3%）患者在30天内需要进行血液透析，sUA水平较高的患者这两种发生率均升高。sUA≥8.0mg/dL与PC-AKI风险增加相关（比值比（OR）为2.62；95%置信区间（CI），1.275.38，P = 0.009）以及血液透析需求相关（OR，5.40；95%CI，1.3921.04，P = 0.015）。与sUA<8.0mg/dL相比，sUA≥8.0mg/dL的患者PC-AKI发生率更高（16.7%对11.1%，P = 0.012），血液透析发生率更高（12.1%对4.3%，P<0.001）。我们得出结论，sUA≥8.0mg/dL与CCT后的肾脏结局较差相关。我们建议高尿酸血症可能作为接受对比增强影像检查患者发生PC-AKI的独立危险因素。
