Distinct Prognostic Role of Serum Uric Acid Levels for Predicting All-Cause Mortality Among Chinese Adults Aged 45~75 Years With and Without Diabetes.
Distinct Prognostic Role of Serum Uric Acid Levels for Predicting All-Cause Mortality Among Chinese Adults Aged 45~75 Years With and Without Diabetes.
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DOI：
10.3389/fendo.2021.782230
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发表时间：
2021
影响因子：
5.2
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Zhu B;Zhang J;Song N;Shi Y;Fang Y;Ding X;Li Y
本研究旨在探讨中国45~75岁成人基线血尿酸（SUA）对全因死亡风险的影响及其与糖尿病的交互关系。该研究设计为一个基于社区的队列，包括2009年至2015年中国健康与营养调查（CHNS）纳入的4467名年龄在45~75岁之间的成年人，随访期为6年。将基线SUA水平分为四分位数，并使用多变量考克斯比例风险模型探讨其与全因死亡率的相关性。进行分层分析，以探讨糖尿病和非糖尿病个体中SUA四分位数与全因死亡率的关系。在26431人年的随访中，共记录了141例死亡（5.3/1000人年）。在141例死亡中，糖尿病组报告了28例死亡（10.1/1000人-年），非糖尿病组记录了113例死亡（4.8/1000人-年）。与SUA第二四分位数相比，观察到第一和第四分位数参与者的全因死亡风险增加（Q1 SUA：aHR=2.1，95%CI 1.1~4.1; Q4 SUA：aHR=2.1，95%CI 1.1~4.0）。根据糖尿病状态对参与者进行分层，显示出非糖尿病个体的U形关联。eGFR下降是糖尿病患者全因死亡的独立危险因素（aHR=0.7，95% CI 0.6~1.0）。我们的研究证明SUA对全因死亡的预测作用可能受糖尿病的调节。低和高SUA水平均与死亡率增加相关，仅在非糖尿病个体中支持U形关联。肾功能不全是全因死亡的独立危险因素，而SUA不是。应进行进一步的研究，以确定应进行干预的SUA水平，并探索目标随访策略，以防止进展导致预后不良。
The current study sought to explore the effect of baseline serum uric acid (SUA) on the risk of all-cause mortality among Chinese adults aged 45~75 years and to determine its interaction relationship with diabetes. The study was designed as a community-based cohort of 4467 adults aged between 45~75 years included in a 6-years follow-up period from 2009 to 2015 years by the China Health and Nutrition Survey (CHNS). Baseline SUA levels were grouped into quartiles and its association on all-cause mortality was explored using multivariate Cox proportional hazards models. Stratified analyses were performed to explore the associations of SUA quartiles with all-cause mortality among diabetic and non-diabetic individuals. A total of 141 deaths (5.3 per 1000 person-years) were recorded During a follow-up of 26431 person-years. Out of the 141 deaths, 28 deaths (10.1 per 1000 person-years) were reported in the diabetic groups and 113 deaths (4.8 per 1000 person-years) were recorded in the non-diabetic group. An increased risk of all-cause mortality was observed for participants in the first and fourth quartiles compared with the second SUA quartile, (Q1 SUA: aHR=2.1, 95% CI 1.1~4.1; Q4 SUA: aHR=2.1, 95% CI 1.1~4.0). Stratification of participants by diabetes status showed a U-shaped association for non-diabetic individuals. Whereas, declined eGFR, rather than SUA, was an independent risk factor for all-cause mortality in diabetic individuals (aHR=0.7, 95% CI 0.6~1.0). Our study proved that the prognostic role of SUA for predicting all-cause death might be regulated by diabetes. Both low and high SUA levels were associated with increased mortality, supporting a U-shaped association only in non-diabetic individuals. Whereas, renal dysfunction rather than SUA was an independent risk factor for all-cause mortality. Further studies should be conducted to determine the SUA levels at which intervention should be conducted and explore target follow-up strategies to prevent progression leading to poor prognosis.
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