Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China.
School of Medicine, Beihang University, Beijing, China.
J Clin Endocrinol Metab. 2020 Jan 1;105(1). doi: 10.1210/clinem/dgz068.
In addition to the controversy regarding the association of hyperuricemia with mortality, uncertainty also remains regarding the association between low serum uric acid (SUA) and mortality. We aimed to assess the relationship between SUA and all-cause and cause-specific mortality.
This cohort study included 9118 US adults from the National Health and Nutrition Examination Survey (1999-2002). Multivariable Cox proportional hazards models were used to evaluate the relationship between SUA and mortality. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and 2-piecewise Cox proportional hazards models, to address the nonlinearity between SUA and mortality.
During a median follow-up of 5.83 years, 448 all-cause deaths occurred, with 100 cardiovascular disease (CVD) deaths, 118 cancer deaths, and 37 respiratory disease deaths. Compared with the reference group, there was an increased risk of all-cause, CVD, cancer, and respiratory disease mortality for participants in the first and third tertiles of SUA. We further found a nonlinear and U-shaped association between SUA and mortality. The inflection point for the curve was found at a SUA level of 5.7 mg/dL. The hazard ratios (95% confidence intervals) for all-cause mortality were 0.80 (0.65-0.97) and 1.24 (1.10-1.40) to the left and right of the inflection point, respectively. This U-shaped association was observed in both sexes; the inflection point for SUA was 6 mg/dL in males and 4 mg/dL in females.
Both low and high SUA levels were associated with increased all-cause and cause-specific mortality, supporting a U-shaped association between SUA and mortality.
除了高尿酸血症与死亡率之间的争议外，低血清尿酸（SUA）与死亡率之间的关系仍存在不确定性。我们旨在评估 SUA 与全因和特定原因死亡率之间的关系。
本队列研究纳入了来自美国国家健康和营养调查（1999-2002 年）的 9118 名美国成年人。多变量 Cox 比例风险模型用于评估 SUA 与死亡率之间的关系。我们的分析包括使用广义加性模型和光滑曲线拟合（惩罚样条法）以及 2 段 Cox 比例风险模型，以解决 SUA 与死亡率之间的非线性关系。
在中位数为 5.83 年的随访期间，发生了 448 例全因死亡，其中 100 例死于心血管疾病（CVD），118 例死于癌症，37 例死于呼吸疾病。与参考组相比，SUA 处于第一和第三三分位数的参与者发生全因、CVD、癌症和呼吸疾病死亡的风险增加。我们进一步发现 SUA 与死亡率之间存在非线性和 U 形关联。该曲线的拐点位于 SUA 水平为 5.7mg/dL 处。拐点左侧和右侧全因死亡率的危险比（95%置信区间）分别为 0.80（0.65-0.97）和 1.24（1.10-1.40）。这种 U 形关联在两性中均可见；男性 SUA 的拐点为 6mg/dL，女性为 4mg/dL。
低 SUA 和高 SUA 水平均与全因和特定原因死亡率增加相关，表明 SUA 与死亡率之间呈 U 形关联。
