系统炎症标志物与高尿酸血症患者死亡率升高独立相关：来自 NHANES 前瞻性队列研究的结果。

Systemic inflammation markers independently associated with increased mortality in individuals with hyperuricemia: Results from the NHANES prospective cohort study.

机构信息

Department of Rheumatology and Immunology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

Department of Epidemiology and Biostatistics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.

出版信息

Immun Inflamm Dis. 2024 Oct;12(10):e70032. doi: 10.1002/iid3.70032.

BACKGROUND

Hyperuricemia is associated with increased systemic inflammation. The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) are novel systemic inflammation markers and prognostic markers. However, no studies have evaluated the association between the SII/SIRI and mortality risk in individuals with hyperuricemia. This study aimed to investigate the predictive value of the SII and SIRI for all-cause and cardiovascular mortality in a large cohort of hyperuricemia patients.

METHODS

We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2020. Hyperuricemia was defined as serum uric acid (SUA) levels of ≥7 mg/dL in men and ≥6 mg/dL in women. The SII and SIRI were calculated based on complete blood count parameters. Associations with all-cause and cardiovascular mortality were analyzed using Cox proportional hazards models. Nonlinearity and effect modification were assessed using restricted cubic splines (RCS) and interaction analysis.

RESULTS

Among the 6181 participants with hyperuricemia aged 20 years and older, over a total 181 months of follow-up, there were 936 all-cause deaths, of which 195 were cardiovascular mortality. In the fully adjusted models, the hazard ratios (HRs) were 1.73 (95% CI 1.42-2.13) for the SII and 2.18 (95% CI 1.82-2.62) for the SIRI with all-cause mortality. The adjusted HRs were 2.08 (95% CI 1.37-3.14) for the SII and 2.32 (95% CI 1.56-3.45) for the SIRI with cardiovascular mortality. Spline models identified nonlinear U-shaped (SII) and J-shaped (SIRI) relationships of inflammation markers with mortality.

CONCLUSIONS

Elevated SII and SIRI are independent predictors of mortality in hyperuricemia patients. These inflammatory biomarkers may improve risk stratification in this high-risk population. Further research should evaluate utility in guiding preventive interventions.

背景

高尿酸血症与全身炎症反应增加有关。系统性免疫炎症指数（SII）和系统性炎症反应指数（SIRI）是新型的全身炎症标志物和预后标志物。然而，目前尚无研究评估 SII/SIRI 与高尿酸血症患者死亡风险之间的关系。本研究旨在探讨 SII 和 SIRI 对大样本高尿酸血症患者全因和心血管死亡率的预测价值。

方法

我们利用 2001 年至 2020 年国家健康和营养调查（NHANES）的数据进行了一项前瞻性队列研究。高尿酸血症定义为男性血清尿酸（SUA）水平≥7mg/dL，女性≥6mg/dL。SII 和 SIRI 是根据全血细胞参数计算得出的。采用 Cox 比例风险模型分析与全因和心血管死亡率的相关性。采用限制性立方样条（RCS）和交互分析评估非线性和效应修饰。

结果

在 6181 名年龄在 20 岁及以上的高尿酸血症患者中，在总计 181 个月的随访期间，共有 936 例全因死亡，其中 195 例为心血管死亡。在完全调整的模型中，SII 的危险比（HR）为 1.73（95%CI 1.42-2.13），SIRI 的 HR 为 2.18（95%CI 1.82-2.62）。SII 的调整后 HR 为 2.08（95%CI 1.37-3.14），SIRI 的调整后 HR 为 2.32（95%CI 1.56-3.45）。折线模型确定了炎症标志物与死亡率之间呈非线性 U 型（SII）和 J 型（SIRI）关系。