Lenz Max, Zilberszac Robert, Hengstenberg Christian, Wojta Johann, Richter Bernhard, Heinz Gottfried, Krychtiuk Konstantin A, Speidl Walter S
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria.
J Clin Med. 2025 Jun 23;14(13):4455. doi: 10.3390/jcm14134455.
: Mitochondrial DNA (mtDNA) has strong pro-inflammatory potential and was found to be associated with mortality in critically ill patients. The purine bases from circulating cell-free DNA, including mtDNA, are catabolised into uric acid, contributing to elevated systemic levels. However, the prognostic value of uric acid in unselected critically ill intensive care unit (ICU) patients remains unclear. We aimed to investigate the association between uric acid levels at admission and 30-day mortality, assess its correlation with mtDNA, and examine prognostic relevance based on the primary cause of admission. : This prospective single-centre study included 226 patients admitted to a tertiary care ICU. Uric acid and mtDNA levels were assessed at admission. Survival analyses were performed in the overall cohort and in subgroups stratified by primary diagnosis. : Uric acid showed a U-shaped association with 30-day mortality, with both low and high levels linked to reduced survival. In multivariate analysis, the 4th quartile of uric acid remained associated with adverse outcomes, independent of sex, vasopressors, mechanical ventilation, and creatinine (HR 2.549, 95% CI: 1.310-4.958, = 0.006). A modest correlation was observed between uric acid and mtDNA (r = 0.214, = 0.020). However, prognostic relevance varied by diagnosis. While uric acid predicted mortality in patients following cardiac arrest ( = 0.017), mtDNA was found to bear prognostic value in cardiogenic shock and decompensated heart failure ( = 0.009). : Uric acid was independently associated with mortality in critically ill patients, with both low and high levels carrying prognostic value. Its predictive capabilities differed from mtDNA but showed partial overlap. However, both markers exhibited varying prognostic performance depending on the primary cause of admission.
线粒体DNA（mtDNA）具有很强的促炎潜力，并且被发现与危重症患者的死亡率相关。循环游离DNA（包括mtDNA）中的嘌呤碱基被分解代谢为尿酸，导致全身水平升高。然而，尿酸在未经过筛选的危重症重症监护病房（ICU）患者中的预后价值仍不清楚。我们旨在研究入院时尿酸水平与30天死亡率之间的关联，评估其与mtDNA的相关性，并根据入院的主要原因检查预后相关性。
这项前瞻性单中心研究纳入了226名入住三级护理ICU的患者。入院时评估尿酸和mtDNA水平。在整个队列以及按主要诊断分层的亚组中进行生存分析。
尿酸与30天死亡率呈U形关联，低水平和高水平均与生存率降低相关。在多变量分析中，尿酸的第4四分位数仍与不良结局相关，独立于性别、血管加压药、机械通气和肌酐（HR 2.549，95%CI：1.310 - 4.958，P = 0.006）。尿酸与mtDNA之间观察到适度的相关性（r = 0.214，P = 0.020）。然而，预后相关性因诊断而异。虽然尿酸可预测心脏骤停患者的死亡率（P = 0.017），但发现mtDNA在心源性休克和失代偿性心力衰竭患者中具有预后价值（P = 0.009）。
尿酸与危重症患者的死亡率独立相关，低水平和高水平均具有预后价值。其预测能力与mtDNA不同，但显示出部分重叠。然而，这两种标志物根据入院的主要原因表现出不同的预后性能。
