Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Endocrinol (Lausanne). 2021 Nov 16;12:782230. doi: 10.3389/fendo.2021.782230. eCollection 2021.
The current study sought to explore the effect of baseline serum uric acid (SUA) on the risk of all-cause mortality among Chinese adults aged 45~75 years and to determine its interaction relationship with diabetes.
The study was designed as a community-based cohort of 4467 adults aged between 45~75 years included in a 6-years follow-up period from 2009 to 2015 years by the China Health and Nutrition Survey (CHNS). Baseline SUA levels were grouped into quartiles and its association on all-cause mortality was explored using multivariate Cox proportional hazards models. Stratified analyses were performed to explore the associations of SUA quartiles with all-cause mortality among diabetic and non-diabetic individuals.
A total of 141 deaths (5.3 per 1000 person-years) were recorded During a follow-up of 26431 person-years. Out of the 141 deaths, 28 deaths (10.1 per 1000 person-years) were reported in the diabetic groups and 113 deaths (4.8 per 1000 person-years) were recorded in the non-diabetic group. An increased risk of all-cause mortality was observed for participants in the first and fourth quartiles compared with the second SUA quartile, (Q1 SUA: aHR=2.1, 95% CI 1.14.1; Q4 SUA: aHR=2.1, 95% CI 1.14.0). Stratification of participants by diabetes status showed a U-shaped association for non-diabetic individuals. Whereas, declined eGFR, rather than SUA, was an independent risk factor for all-cause mortality in diabetic individuals (aHR=0.7, 95% CI 0.6~1.0).
Our study proved that the prognostic role of SUA for predicting all-cause death might be regulated by diabetes. Both low and high SUA levels were associated with increased mortality, supporting a U-shaped association only in non-diabetic individuals. Whereas, renal dysfunction rather than SUA was an independent risk factor for all-cause mortality. Further studies should be conducted to determine the SUA levels at which intervention should be conducted and explore target follow-up strategies to prevent progression leading to poor prognosis.
本研究旨在探讨基线血清尿酸（SUA）对 45~75 岁中国成年人全因死亡率的影响，并确定其与糖尿病的相互关系。
本研究设计为一项社区为基础的队列研究，纳入了 2009 年至 2015 年期间参加中国健康与营养调查（CHNS）的 4467 名 45~75 岁成年人，随访 6 年。将基线 SUA 水平分为四分位，并使用多变量 Cox 比例风险模型探讨其与全因死亡率的关系。进行分层分析以探讨 SUA 四分位数与糖尿病和非糖尿病个体全因死亡率的关系。
在 26431 人年的随访期间，共记录了 141 例死亡（每 1000 人年 5.3 例）。在这 141 例死亡中，28 例（每 1000 人年 10.1 例）发生在糖尿病组，113 例（每 1000 人年 4.8 例）发生在非糖尿病组。与第二 SUA 四分位数相比，第一和第四四分位数的参与者全因死亡率风险增加（Q1 SUA：aHR=2.1，95%CI 1.14.1；Q4 SUA：aHR=2.1，95%CI 1.14.0）。按糖尿病状态分层显示，非糖尿病个体呈 U 形关联。然而，在糖尿病个体中，eGFR 下降而不是 SUA 是全因死亡的独立危险因素（aHR=0.7，95%CI 0.6~1.0）。
我们的研究证明，SUA 预测全因死亡的预后作用可能受到糖尿病的调节。低和高 SUA 水平均与死亡率增加相关，仅在非糖尿病个体中呈 U 形关联。然而，肾功能不全而不是 SUA 是全因死亡的独立危险因素。应进一步开展研究以确定应进行干预的 SUA 水平，并探索针对目标随访策略以防止进展导致不良预后。
