Joint association of ankle-brachial index and serum uric acid on the outcomes of six-year all-cause mortality and cardiovascular mortality in Chinese patients

Abstract Background: Studies on the correlation between serum uric acid (SUA) and all-cause mortality in peritoneal dialysis (PD) patients were mainly based on the results of baseline SUA. We aimed to analyze the change of SUA level post PD, and the correlation between follow-up SUA and prognosis in PD patients. Methods: All patients who received PD catheterization and maintaining PD in our center from March 2, 2001 to March 8, 2017 were screened. Kaplan-Meier and Cox proportional-hazards regression models were used to analyze the effect of SUA levels on the risks of death. We graded SUA levels at baseline, 6 months, 12 months, 18 months and 24 months post PD by mean of SUA plus or minus a standard deviation as cut-off values, and compared all-cause and cardiovascular mortality among patients with different SUA grades. Results: A total of 1402 patients were included, 763 males (54.42%) and 639 females (45.58%). Their average age at PD start was 49.50±14.20 years. The SUA levels were 7.97±1.79mg/dl at baseline, 7.12±1.48mg/dl at 6 months, 7.05±1.33mg/dl at 12 months, 7.01±1.30mg/dl at 18 months, and 6.93±1.26mg/dl at 24 months. During median follow-up time of 31 (18, 49) months, 173 (12.34%) all-cause deaths occurred, including 68 (4.85%) cardiovascular deaths. There were no significant differences on all-cause mortality among groups with graded SUA levels at baseline, 12 months, 18 months and 24 months during follow-up or on cardiovascular mortality among groups with graded SUA levels at baseline, 6 months, 12 months, 18 months and 24 months during follow-up. At 6 months post PD，Kaplan Meier analysis showed there was significant difference on all-cause mortality among graded SUA levels (c2=11.315, P=0.010), and the all-cause mortality was lowest in grade of 5.65mg/dl≤SUA<7.13mg/dl. Conclusion: SUA level decreased during follow up post PD. At 6 months post PD, a grade of 5.65mg/dl≤SUA<7.13mg/dl was appropriate for better patients’ survival.

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Serum Uric Acid Revealed a U-Shaped Relationship With All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: The ASSURE Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.641513 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yan Cang ◽

Shaojie Xu ◽

Jingyin Zhang ◽

Jingyi Ju ◽

Zijun Chen ◽

...

Keyword(s):

Uric Acid ◽

Regression Model ◽

Serum Uric Acid ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Multicenter Cohort Study ◽

Male And Female ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Cvd Mortality

Background: Previous studies have demonstrated an association between hyperuricemia and cardiovascular disease (CVD). The Framingham study confirmed that patients with high atherosclerotic risks (HARs) had worse prognoses. However, after adjusting for confounding factors, the association between serum uric acid (SUA) and all-cause mortality and cardiovascular mortality remains unclear, especially for HAR patients.Objective: The aim of this study was to reveal the relationship of SUA with all-cause and cardiovascular mortality in HAR patients.Methods: This multicenter cohort study enrolled 3,047 participants, and the follow-up was 68.85 ± 11.37 months. Factors related to cardiovascular and all-cause mortality were tested by multivariate Cox regression analysis. Restricted cubic splines (RCSs) with knots were used to explore the shape of the dose–response relationship with SUA and the hazard ratio (HR) of all-cause and CVD mortality. SUA transformed by RCS was added to the Cox regression model as an independent variable, and all-cause and CVD mortality scores were calculated. Survival receiver operating characteristic curves were produced using a regression model predicting the score.Results: SUA demonstrated a “U-shaped” relationship with all-cause and cardiovascular mortality. SUA predicted all-cause and CVD mortality, with cutoff values of values of >370.5 μmol/L for males and >327.65 μmol/L for females and <180.5 μmol/L for males and <165.7 μmol/L for females, respectively. The survival ROC curve indicated that SUA is able to predict all-cause and CVD mortality, with areas under the curve of 0.702 and 0.711, respectively. The HRs of all-cause mortality (male and female) with hyperuricemia and hypouricemia were 2.08 and 2.01 and 2.04 and 1.98, respectively, and the HRs of CVD mortality (male and female) were 2.09 and 1.79, and 2.02 and 1.89, respectively.Conclusion: Abnormal SUA levels were significant and independent risk factors for all-cause and CVD mortality. Hyperuricemia and hypouricemia increased mortality in both males and females. Routine SUA evaluation and intensive management are needed for HAR patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03616769.

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Relationship of a Low Ankle-brachial Index with All-cause Mortality and Cardiovascular Mortality in Chinese Patients with Metabolic Syndrome after a 6-Year Follow-up: A Chinese Prospective Cohort Study

Internal Medicine ◽

10.2169/internalmedicine.51.7718 ◽

2012 ◽

Vol 51 (20) ◽

pp. 2847-2856 ◽

Cited By ~ 9

Author(s):

Yan Cang ◽

Jue Li ◽

Yuan-min Li ◽

Yun Zhou ◽

Yue-zhou Wu ◽

...

Keyword(s):

Metabolic Syndrome ◽

Cohort Study ◽

Prospective Cohort Study ◽

Cardiovascular Mortality ◽

Prospective Cohort ◽

Ankle Brachial Index ◽

Chinese Patients ◽

All Cause Mortality ◽

Relationship Of

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Association between serum uric acid and cardiovascular mortality and all-cause mortality

Journal of Hypertension ◽

10.1097/hjh.0000000000001330 ◽

2017 ◽

Vol 35 ◽

pp. S3-S9 ◽

Cited By ~ 15

Author(s):

EunSun Cheong ◽

Seungho Ryu ◽

Jong-Young Lee ◽

Sung Ho Lee ◽

Joo-Wook Sung ◽

...

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Cardiovascular Mortality ◽

All Cause Mortality

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Serum Uric Acid Showed U-shaped Relationship with All-Cause Mortality and Cardiovascular Mortality in High Atherosclerosis Risk Patients: ASSURE Study

10.21203/rs.3.rs-60123/v1 ◽

2020 ◽

Author(s):

Yan Cang ◽

Shaojie Xu ◽

Jinying Zhang ◽

Zijun Chen ◽

Keke Wang ◽

...

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Rank Test ◽

Cardiac Events ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Risk Patients ◽

Restricted Cubic Splines

Abstract Background: Previous studys have demonstrated association between hyperuricemia and cardiovascular disease (CVD), and Framingham study has confirmed patients with high atherosclerotic risk (HAR) had worse prognosis. But after controlling other traditional atherosclerotic risks, the association between serum uric acid (SUA) and all-cause mortality, cardiovascular mortality remains controversial, especially in HAR patients.Objective: The aim of study was to reveal the relationship with SUA and all-cause mortality, cardiovascular mortality in HAR patients.Methods: The multi-center cohort study comprised 3,640 participants (1927male, 1713 female),whose mean age was 60.2±10.4 years andmean follow-uptimewere 68.85±11.37 months. Factors related to cardiovascular mortality and all-cause mortality, major adverse cardiac events in-hospital during follow-up were tested by multivariate Cox regression analysis and log-rank test. Restricted cubic splines with knots were used to explore theshape of dose-response relationship with SUA levels and Hazard risk (HR) of all-cause and CVD mortality.Results：The study showed SUA presented U-shaped relationship with all-cause and cardiovascular mortality. HR of all-cause mortality with hyperuricemia and hypouricemia was 2.11, 95% CI(1.61-3.07), and 2.05, 95% CI(1.35-2.90), respectively. HR of Cardiovascular mortality was 2.42, 95% CI (1.61-3.12), and 1.95, 95% CI(1.29-2.90), respectively. Conclusion：Abnormal SUA levels maybe significant and independent risk factors for all-cause and cardiovascular mortality. Routine SUA evaluation and intensive management are pressing needed, especially in HAR patients.

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Relationship between serum uric acid level and all-cause and cardiovascular mortality in population with obesity

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137236 ◽

2020 ◽

Vol 96 (1141) ◽

pp. 660-665 ◽

Cited By ~ 1

Author(s):

Jie LI ◽

Jia-Yi Huang ◽

Lin Liu ◽

Kenneth Lo ◽

Shuo Sun ◽

...

Keyword(s):

Uric Acid ◽

Linear Regression ◽

Serum Uric Acid ◽

Cardiovascular Mortality ◽

Serum Uric Acid Level ◽

Piecewise Linear ◽

Generalised Additive Model ◽

Piecewise Linear Regression ◽

All Cause Mortality

BackgroundWe aimed to investigate the association between serum uric acid (SUA) and all-cause or cardiovascular mortality among participants with obesity.MethodAll participants were included from the 1999 to 2014 National Health and Nutrition Examination Survey with follow-up mortality assessment through 31 December 2015. Cox proportional hazards models were built to estimate adjusted HRs and 95% CIs for mortality according to baseline uric acid in quartiles. Obesity was defined as body mass index ≥30 (kg/m2). Generalised additive model (GAM) and two-piecewise linear regression models were performed to explore any non-linearity in associations.ResultsThere were 12 637 adults with obesity eligible for analysis. There were 999 (7.91%) all-cause and 147 (1.16%) cardiovascular mortality occurred during the mean follow-up of 98.11 months. Comparing with the lowest quartile of SUA, the highest SUA group did not have significant association with all-cause (HR 1.08, 95% CI 0.76 to 1.52) and cardiovascular mortality (HR 1.63, 95% CI 0.58 to 4.53) after adjusting for various confounding factors. GAM and two-piecewise linear regression model demonstrated a non-linearly relationship between SUA and all-cause mortality, and the corresponding cut-off point was 6.5 mg/dL. However, there is no significant relationship between uric acid and cardiovascular death on both sides of the cut-off value of 6.1 mg/dL.ConclusionsSUA showed a J-shaped relationship with all-cause mortality, but no significant with cardiovascular mortality in adults with obesity.

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Serum Uric Acid and Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Blood Purification ◽

10.1159/000513944 ◽

2021 ◽

pp. 1-9

Author(s):

Jialing Zhang ◽

Xiangxue Lu ◽

Han Li ◽

Shixiang Wang

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Cochrane Library ◽

Random Effects Models ◽

Hazard Ratios ◽

Increased Risk ◽

All Cause Mortality ◽

The Cochrane Library

Background: Existing studies suggested conflicting relationships between serum uric acid (SUA) and mortality in CKD patients. The present meta-analysis aimed to determine whether SUA can be a predictor for mortality in CKD cohorts. Method: A systematical search was conducted on PubMed, EMBASE, and The Cochrane Library to identify studies reporting the relationship between SUA level and all-cause and cardiovascular mortality in CKD populations. In addition, random-effects models were adopted to calculate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Results: On the whole, 29 studies were involved. In the present meta-analysis, patients exhibiting the maximum SUA level showed an association with a significantly higher risk for all-cause mortality (HR, 1.30; 95% CI, 1.06–1.59) compared with patients exhibiting the minimum SUA level. As revealed from the meta-analysis of 8 studies, low level of SUA was another predictor for all-cause mortality in patients with CKD (HR, 1.36; 95% CI, 1.20–1.54). No significant relationship was identified between SUA and cardiovascular mortality. Conclusions: Higher and lower SUA levels are both associated with significantly increased risk of all-cause mortality in patients with CKD. A appreciate dose of treatment of lowering SUA agents should be confirmed.

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