Chen Bo, Lu Chenyang, Gu Hong-Qiu, Li Yang, Zhang Guqin, Lio Jonathan, Luo Xiongyan, Zhang Lingshu, Hu Yidan, Lan Xiaomeng, Chen Zerong, Xie Qibing, Pan Huaqin
Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Endocrinol (Lausanne). 2021 May 6;12:633767. doi: 10.3389/fendo.2021.633767. eCollection 2021.
Although hyperuricemia frequently associates with respiratory diseases, patients with severe coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) can show marked hypouricemia. Previous studies on the association of serum uric acid with risk of adverse outcomes related to COVID-19 have produced contradictory results. The precise relationship between admission serum uric acid and adverse outcomes in hospitalized patients is unknown.
Data of patients affected by laboratory-confirmed COVID-19 and admitted to Leishenshan Hospital were retrospectively analyzed. The primary outcome was composite and comprised events, such as intensive care unit (ICU) admission, mechanical ventilation, or mortality. Logistic regression analysis was performed to explore the association between serum concentrations of uric acid and the composite outcome, as well as each of its components. To determine the association between serum uric acid and in-hospital adverse outcomes, serum uric acid was also categorized by restricted cubic spline, and the 95% confidence interval (CI) was used to estimate odds ratios (OR).
The study cohort included 1854 patients (mean age, 58 years; 52% women). The overall mean ± SD of serum levels of uric acid was 308 ± 96 µmol/L. Among them, 95 patients were admitted to ICU, 75 patients received mechanical ventilation, and 38 died. In total, 114 patients reached composite end-points (have either ICU admission, mechanical ventilation or death) during hospitalization. Compared with a reference group with estimated baseline serum uric acid of 279-422 µmol/L, serum uric acid values ≥ 423 µmol/L were associated with an increased risk of composite outcome (OR, 2.60; 95% CI, 1.07- 6.29) and mechanical ventilation (OR, 3.01; 95% CI, 1.06- 8.51). Serum uric acid ≤ 278 µmol/L was associated with an increased risk of the composite outcome (OR, 2.07; 95% CI, 1.18- 3.65), ICU admission (OR, 2.18; 95% CI, 1.17- 4.05]), and mechanical ventilation (OR, 2.13; 95% CI, 1.06- 4.28), as assessed by multivariate analysis.
This study shows that the association between admission serum uric acid and composite outcome of COVID-19 patients was U-shaped. In particular, we found that compared with baseline serum uric acid levels of 279-422 µmol/L, values ≥ 423 µmol/L were associated with an increased risk of composite outcome and mechanical ventilation, whereas levels ≤ 278 µmol/L associated with increased risk of composite outcome, ICU admission and mechanical ventilation.
尽管高尿酸血症常与呼吸系统疾病相关，但新型冠状病毒肺炎（COVID-19）重症患者和严重急性呼吸综合征（SARS）患者可出现明显的低尿酸血症。既往关于血清尿酸与COVID-19相关不良结局风险的研究结果相互矛盾。住院患者入院时血清尿酸与不良结局的确切关系尚不清楚。
对在雷神山医院住院的实验室确诊COVID-19患者的数据进行回顾性分析。主要结局为综合结局，包括重症监护病房（ICU）入住、机械通气或死亡等事件。进行逻辑回归分析以探讨血清尿酸浓度与综合结局及其各组成部分之间的关联。为确定血清尿酸与住院期间不良结局之间的关联，还采用受限立方样条对血清尿酸进行分类，并使用95%置信区间（CI）估计比值比（OR）。
研究队列包括1854例患者（平均年龄58岁；52%为女性）。血清尿酸水平的总体均值±标准差为308±96μmol/L。其中，95例患者入住ICU，75例患者接受机械通气，38例死亡。共有114例患者在住院期间达到综合终点（入住ICU、接受机械通气或死亡）。与估计基线血清尿酸为279 - 422μmol/L的参照组相比，血清尿酸值≥423μmol/L与综合结局风险增加相关（OR，2.60；95%CI，1.07 - 6.29）和机械通气风险增加相关（OR，3.01；95%CI，1.06 - 8.51）。多因素分析评估显示，血清尿酸≤278μmol/L与综合结局风险增加相关（OR，2.07；95%CI，1.18 - 3.65）、ICU入住风险增加相关（OR，2.18；95%CI，1.17 - 4.05）以及机械通气风险增加相关（OR，2.13；95%CI，1.06 - 4.28）。
本研究表明，COVID-19患者入院时血清尿酸与综合结局之间的关联呈U形。具体而言，我们发现与基线血清尿酸水平279 - 422μmol/L相比，≥423μmol/L的值与综合结局和机械通气风险增加相关，而≤278μmol/L的水平与综合结局、ICU入住和机械通气风险增加相关。
