急性肾损伤患者高尿酸血症与死亡率之间的关系

The Association between Hyperuricemia and Mortality in Patients with Acute Kidney Injury

摘要: 目的：探讨急性肾损伤患者高尿酸血症与死亡率的关系。方法：回顾性收集2015年1月1日至2020年7月31日于青岛大学附属医院住院并发生AKI的4646例患者的临床资料。AKI诊断标准依照KDIGO定义与分期进行判断。将血尿酸高于360 μmol/L (女性)、>420 μmol/L (男性以及绝经女性)作为高尿酸血症的确诊依据。使用logistic回归模型对AKI病人血尿酸程度以及住院死亡比例之间的联系进行分析。结果：4646例患者中高尿酸血症患者为1316例(28.3%)。患者总体死亡率为7.7% (n = 358)，高尿酸血症组死亡率显著高于非高尿酸血症组(12.8%比5.7%，P < 0.001)。进一步采用logistic回归模型校正年龄、性别、合并症、生化指标及用药等因素后发现，高尿酸血症组患者死亡风险是非高尿酸血症组的1.62倍，当基线血尿酸水平每增加100 μmol/L，患者死亡风险增加38.1% (OR = 1.381, 95%CI 1.304~1.462, P < 0.001)。亚组分析显示，在eGFR ≥ 60 (ml/min)亚组中，两组患者死亡率无统计学意义；而在eGFR < 60 (ml/min)亚组中，高尿酸血症组患者死亡率显著高于非高尿酸血症组(14.6%比8.9%，P < 0.001)。在AKI分期亚组中，和非高尿酸血症组进行比较，高尿酸血症组病人的死亡率有所上升(AKI 1期：11.2%比5.1%，AKI 2期：23.3%比10.6%，AKI 3期：29.8%比10.5%，均P < 0.05)。结论：高尿酸血症和AKI患者病人住院死亡率之间有一定的相关性。高尿酸血症是导致AKI病人死亡的危险因素，在临床的治疗中我们需要重视。

Abstract: Objective: To investigate the association between hyperuricemia and hospital mortality in patients with acute kidney injury. Methods: Clinical data of 4646 patients with AKI in the Affiliated Hospital of Qingdao University from January 1, 2015 to July 31, 2020 were collected. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Hyperuricemia is defined as serum uric acid > 360 μmol/L (female) and >420 μmol/L (men and postmenopausal women). Logistic regression model was used to evaluate the association between serum uric acid level and hospital mortality in patients with AKI. Results: A total of 4646 patients were included, among whom, 1316 patients were diagnosed with hyperuricemia (28.3%). The overall mortality rate was 7.7% (n = 358). The mortality rate in the hyperuricemia group was significantly higher than that in the non-hyperuricemia group (12.8% vs. 5.7%, P < 0.001). Logistic regression model was used to adjust for age, sex, complications, biochemical indicators and drug use, and it was found that the risk of death in the hyperuricemia group was 1.62 times that in the non-hyperuricemia group. When baseline uric acid level increased by 100 μmol/L, the risk of death in the hyperuricemia group increased by 38.1% (OR = 1.381, 95%CI 1.30~1.462, P < 0.001). Subgroup analysis showed that in the eGFR ≥ 60 (ml/min) subgroup, there was no statistically significant difference in mortality between the two groups. In the eGFR < 60 (ml/min) subgroup, mortality was significantly higher in the hyperuricemia group than in the non-hyperuricemia group (14.6% vs. 8.9%, P < 0.001). In the AKI staging subgroup, mortality was higher in the hyperuricemia group than in the non-hyperuricemia group (all P < 0.05). Conclusion: Hyperuricemia is associated with increased hospital mortality in AKI patients. Hyperuricemia is an independent risk factor for death in patients with AKI.