Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy.
Cardiology IV, ASST GOM Niguarda, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Eur J Intern Med. 2020 Dec;82:62-67. doi: 10.1016/j.ejim.2020.07.013. Epub 2020 Jul 22.
To assess the association between admission serum uric acid (SUA) levels and in-hospital outcomes in a real-world patients population with acute coronary syndrome (ACS) and to investigate the potential incremental prognostic value of SUA added to GRACE score (GRACE-SUA score).
The data of consecutive ACS patients admitted to Coronary Care Unit of San Paolo and Niguarda hospitals in Milan (Italy) were retrospectively analyzed.
1088 patients (24% female) were enrolled. Mean age was 68 years (IQR 60-78). STEMI and NSTE-ACS patients were 504 (46%) and 584 (54%) respectively. SUA (OR 1.72 95%CI 1.33-2.22, p < 0.0001) and GRACE score (OR 1.04 95%CI 1.02-1.06, p < 0.0001) were significantly associated with an increased risk of in-hospital death at the multivariate analysis. Admission values of SUA were stratified in four quartiles. Rates of acute kidney injury, implantation of intra-aortic balloon pump and non-invasive ventilation use were significantly higher in the last quartile compared to Q1, Q2 and Q3 (p < 0.01). The areas under the ROC curve (AUC) for GRACE score and for SUA were 0.91 (95% CI 0.89-0.93, p < 0.0001) and 0.79 (95% CI 0.76-0.81, p < 0.0001) respectively. The AUC was larger for predicting in-hospital mortality with the GRACE-SUA score (0.94; 95% CI 0.93-0.95).
High admission levels of SUA are independently associated with in-hospital adverse outcomes and mortality in a contemporary population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality in this study population.
评估入院时血清尿酸（SUA）水平与急性冠脉综合征（ACS）患者住院期间结局的相关性，并探讨 SUA 增加 GRACE 评分（GRACE-SUA 评分）的潜在增量预后价值。
回顾性分析了米兰圣保禄和尼瓜尔达医院冠心病监护病房连续收治的 ACS 患者的数据。
共纳入 1088 例患者（24%为女性），平均年龄 68 岁（IQR 60-78 岁）。其中，ST 段抬高型心肌梗死和非 ST 段抬高型 ACS 患者分别为 504 例（46%）和 584 例（54%）。多变量分析显示，SUA（OR 1.72，95%CI 1.33-2.22，p<0.0001）和 GRACE 评分（OR 1.04，95%CI 1.02-1.06，p<0.0001）与住院期间死亡风险增加显著相关。入院时 SUA 值分为四个四分位区间。与 Q1、Q2 和 Q3 相比，第 4 个四分位区间的急性肾损伤、主动脉内球囊泵植入和无创通气使用率明显更高（p<0.01）。GRACE 评分和 SUA 的 ROC 曲线下面积（AUC）分别为 0.91（95%CI 0.89-0.93，p<0.0001）和 0.79（95%CI 0.76-0.81，p<0.0001）。GRACE-SUA 评分预测住院期间死亡率的 AUC 更大（0.94；95%CI 0.93-0.95）。
入院时 SUA 水平较高与当代 ACS 患者住院期间不良结局和死亡率独立相关。在本研究人群中，将 SUA 纳入 GRACE 风险评分似乎可以更准确地预测住院期间的死亡率。
