Yan Lu, Huang Zhihua, Zhao Zhihui, Zhao Qing, Tang Yi, Zhang Yi, Li Xin, Duan Anqi, Luo Qin, Liu Zhihong
Center for Respiratory and Pulmonary Vascular Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, The Clinical Medical Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, China.
Front Med (Lausanne). 2022 Jan 26;9:805415. doi: 10.3389/fmed.2022.805415. eCollection 2022.
Serum uric acid (UA) has long been identified as a prognostic factor of adverse outcomes in pulmonary hypertension. However, there remains a paucity of evidence on patients with idiopathic pulmonary artery hypertension (IPAH) in the era of targeted drug therapy. This study aims to explore the impact of serum UA levels on the disease severity and mortality in patients with IPAH.
Consecutive patients diagnosed with IPAH were enrolled, from which UA levels at baseline and the first follow-up were collected. Patients were divided into groups of "hyperuricemia," which is defined as serum UA level ≥357 μmol/L in women and ≥420 μmol/L in men, and otherwise "normouricemia." The potential relationship between UA and hemodynamics at right heart catheterization was investigated. Associations between UA and survival were evaluated by Kaplan-Meier analysis and Cox proportional hazard modeling.
Of 207 patients with IPAH, 121 (58.5%) had hyperuricemia. Higher serum UA levels were associated with lower cardiac index ( = 0.47, < 0.001) and higher pulmonary vascular resistance ( = 0.36, < 0.001). During a median follow-up of 34 months, there were 32 deaths recorded, accounting for a 15.5% mortality rate. Patients with hyperuricemia had a significantly lower survival rate than those with normouricemia (log-rank test, = 0.002). Hyperuricemia at baseline was independently associated with a 2.6-fold increased risk of 5-year death, which was consistent across different subgroups, especially in females and those aged ≥30 years (each < 0.05). Individuals with higher variability in UA had a higher mortality than those with stable UA (log-rank test, = 0.024).
Baseline hyperuricemia and high variability in serum UA at first follow-up were related to a higher rate of 5-year mortality in patients with IPAH. Closely detecting the UA levels may aid in the early recognition of IPAH patients at higher mortality risk.
血清尿酸（UA）长期以来一直被视为肺动脉高压不良预后的一个危险因素。然而，在靶向药物治疗时代，关于特发性肺动脉高压（IPAH）患者的相关证据仍然匮乏。本研究旨在探讨血清UA水平对IPAH患者疾病严重程度和死亡率的影响。
纳入连续诊断为IPAH的患者，收集其基线和首次随访时的UA水平。患者被分为“高尿酸血症”组（女性血清UA水平≥357μmol/L，男性≥420μmol/L），其余为“正常尿酸血症”组。研究UA与右心导管检查时血流动力学之间的潜在关系。通过Kaplan-Meier分析和Cox比例风险模型评估UA与生存率之间的关联。
207例IPAH患者中，121例（58.5%）患有高尿酸血症。较高的血清UA水平与较低的心指数（r = 0.47，P < 0.001）和较高的肺血管阻力（r = 0.36，P < 0.001）相关。在中位随访34个月期间，记录到32例死亡，死亡率为15.5%。高尿酸血症患者的生存率显著低于正常尿酸血症患者（对数秩检验，P = 0.002）。基线高尿酸血症与5年死亡风险增加2.6倍独立相关，在不同亚组中均一致，尤其是女性和年龄≥30岁的患者（均P < 0.05）。UA变异性较高的个体比UA稳定的个体死亡率更高（对数秩检验，P = 0.024）。
基线高尿酸血症和首次随访时血清UA的高变异性与IPAH患者5年死亡率较高相关。密切检测UA水平可能有助于早期识别死亡风险较高的IPAH患者。
