Han Yong, Chen Cheng, Qin Suyuan, Liu Dongli, Pang Yusheng
Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Front Cardiovasc Med. 2024 Jul 23;11:1404755. doi: 10.3389/fcvm.2024.1404755. eCollection 2024.
Pediatric dilated cardiomyopathy (DCM) is a primary cause of heart failure, highlighting the urgent need for effective prognostic markers.
We performed a single-center retrospective study involving 145 children diagnosed with DCM, with a median follow-up period of 4.0 months (interquartile range: 6.2-108.4 months). The relationship between serum uric acid (SUA) levels and all-cause mortality was assessed using Kaplan-Meier survival curves, multivariate Cox proportional hazard models, and restricted cubic spline (RCS) models.
Of the 145 children with DCM (median age 5.7 years; 61.4% male), 45 (31%) died within 1 year, and 65 (44.8%) died during the maximum follow-up period. In adjusted multivariate Cox regression models, each log2 SUA increase was linked to a higher risk of 1-year mortality [hazard ratio (HR), 2.66; 95% confidence interval (CI), 1.41-5.01] and overall mortality (HR, 1.97; 95% CI, 1.15-3.37). The highest SUA tertile showed a greater risk of mortality at 1 year (HR, 4.26; 95% CI: 1.5-12.06) and during the maximum follow-up (HR, 2.56; 95% CI: 1.06-6.16) compared with the lowest tertile. RCS models indicated an inverted L-shaped association between baseline SUA levels and overall mortality risk, with age-stratified analyses revealing a linear and U-shaped relationship in children ≤10 and >10 years, respectively. Further age-stratified analyses highlighted the modifying effect of age on this association.
Elevated SUA levels are a significant predictor of mortality in pediatric DCM, with a pronounced impact on children under 10 years of age. Therefore, SUA levels could serve as potential biomarkers for risk stratification in this population.
小儿扩张型心肌病（DCM）是心力衰竭的主要病因，凸显了对有效预后标志物的迫切需求。
我们开展了一项单中心回顾性研究，纳入了145例诊断为DCM的儿童，中位随访期为4.0个月（四分位间距：6.2 - 108.4个月）。使用Kaplan-Meier生存曲线、多变量Cox比例风险模型和受限立方样条（RCS）模型评估血清尿酸（SUA）水平与全因死亡率之间的关系。
在145例DCM儿童中（中位年龄5.7岁；61.4%为男性），45例（31%）在1年内死亡，65例（44.8%）在最长随访期内死亡。在调整后的多变量Cox回归模型中，SUA每增加一个log2与1年死亡率的较高风险相关[风险比（HR），2.66；95%置信区间（CI），1.41 - 5.01]以及总体死亡率（HR，1.97；95% CI，1.15 - 3.37）。与最低三分位数相比，最高SUA三分位数在1年时（HR，4.26；95% CI：1.5 - 12.06）和最长随访期内（HR，2.56；95% CI：1.06 - 6.16）显示出更高的死亡风险。RCS模型表明基线SUA水平与总体死亡风险之间呈倒L形关联，年龄分层分析显示在≤10岁和>10岁的儿童中分别呈线性和U形关系。进一步的年龄分层分析突出了年龄对这种关联的调节作用。
SUA水平升高是小儿DCM死亡率的重要预测指标，对10岁以下儿童影响显著。因此，SUA水平可作为该人群风险分层的潜在生物标志物。
