Prognostication and survival analysis of patients with gout or hyperuricemia

• Main Authors: Chang-Fu Kuo, 郭昶甫
• Other Authors: S. F. Luo
• Format: Others
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/56344773291861354857

碩士 === 長庚大學 === 臨床醫學研究所 === 98 === Uric acid is the end product of purine metabolism. In addition to gout, hyperuricemia is related to various health problems, including chronic kidney disease (CKD), metabolic syndrome, hypertension, and ischemic heart disease. However, whether serum uric acid (SUA) itself predisposes to these various complications is still in debate. As hyperuricemia is commonly associated with other medical conditions that are often associated with poorer prognosis, the risk posed by hyperuricemia needs further clarification. We found solid evidence linking hyperuricemia and accelerated eGFR decline. The complex relationships among hyperuricemia, CKD and metabolic syndrome were demonstrated. Patients with hyperuricemia have increased arterial stiffness and cardiac hypertrophy, both contributed to high cardiovascular risks. In a pediatric cohort, children and adolescents with hyperuricemia were found to have high risk of death, in particular kidney and cardiovascular diseases. Interestingly, we found a U shaped association between SUA levels and mortality. The risk associated with low SUA levels was primarily due to stroke and cancer. Importantly, the U shaped association was evident across different patient groups. Next we conducted studies in gout patients. The risk of NAFLD was higher in gout patients than controls, after adjust for multiple variables. A high overall and cardiovascular mortality in patients with gout was documented in this study. This association was adjusted by multiple variables. In addition, we conducted another study incorporated all gout patients in CGMH and compare the mortality with the national population of Taiwan. Overall mortality was higher in gout patients in comparison with the national population. The SMR was higher in females (1.70) than males (1.29); however, the true mortality was no different after adjusted for multiple variables. The causes of death was significantly higher due to kidney, endocrine and cardiovascular diseases. As a whole, the present study demonstrates the important role of hyperuricemia and gout in health. The risks are underestimated by the medical community. For gout patients, aggressive interventions for cardiovascular and renal risks are warranted. With or without gout, hyperuricemia is associated with poorer outcome. SUA should be listed into regular health screening for the general population. Hyperuricemic individuals should be treated with caution in order to prevent unfavorable outcomes.