Preoperative Serum Uric Acid Level Research Articles

Low preoperative serum uric acid is associated with early acute kidney injury after living donor liver transplantation.

Liver transplantation is treatment option for patients with end-stage liver disease and hepatocellular carcinoma. Renal function deterioration significantly impacts the survival rates of liver recipients, and serum uric acid (SUA) is associated with both acute and chronic renal function disorders. Thus, our study aimed to assess the relationship and predictive value of preoperative SUA level and postoperative acute kidney injury (AKI) in living donor liver transplantation (LDLT). We conducted a prospective observational study on 87 patients undergoing LDLT. Blood samples were collected immediately before LDLT, and renal function status was followed up for 3 consecutive days postoperatively. Low SUA levels (cutoff value 4.15 mg/dL) were associated with a high risk of early posttransplantation AKI. The area under the curve was 0.73 (sensitivity, 79.2%; specificity, 59.4%). Although not statistically significant, there were no deaths in the non-AKI group but two in the early AKI group secondary to liver graft dysfunction in addition to early AKI within the first month after LDLT. AKI after liver transplantation may lead to a deterioration of patient status and increased mortality rates. We determined low preoperative SUA levels as a possible risk factor for early postoperative AKI.

Pre-Operative Serum Uric Acid Level is a Predictor of Acute Kidney Injury Subsequent off Pump Coronary Artery Bypass Grafting

Pre-Operative Serum Uric Acid Level is a Predictor of Acute Kidney Injury Subsequent off Pump Coronary Artery Bypass Grafting

The Role Of Serum Uric Acid And Uric Acid To Albumin Ratio For Predicting Of Lymph Node Metastasis In Lung Cancer Treated Surgically By Vats.

In recent years, a correlation between prognosis of various cancers and inflammation has been emphasized in many studies. Uric acid which is a purine metabolite is one of the serum inflammation markers. Albumin is a major component of serum protein and it is used as a parameter reflecting nutritional status and cancer aggressiveness. Here, we have investigated whether preoperative serum uric acid levels, albumin levels, and uric acid to albumin ratio predict lymph node metastasis in non-small cell lung cancer treated surgically by VATS. The medical records of patients underwent VATS lobectomy-segmentectomy for non-small cell lung cancer between January 2015 and December 2020, were reviewed retrospectively. Cut-off values of preoperative serum uric acid, albumin and uric acid to albumin ratio were determined by Receiver Operating Characteristics (ROC) analysis. Groups with and without lymph node metastasis were created according to hilar and/or mediastinal lymph node metastasis. In addition, high and low groups were created according to preoperative uric acid levels and uric acid to albumin ratio. Pearson chi-square test was used investigate whether any significant correlation between the groups. A total of 115 patients were included in the study. Lymph node metastasis in N1 and N2 stations was detected in 11 and 18 patients, respectively. Cut-off values for uric acid and uric acid to albumin ratio were 5.97 mg/dL and 1.28x10-3, respectively. There was a statistically significant correlation between lymph node metastasis and high uric acid levels (p=0.008, OR: 3.2) and high uric acid to albumin ratio (p=0.03, OR: 2.6). Preoperative serum uric acid and uric acid to albumin ratio can predict the lymph node metastasis in non-small cell lung cancer treated surgically by video assisted thoracic surgery.

Značaj nivoa serumske mokraćne kiseline i sintaks skora u dugoročnom preživljavanju kardiohirurških bolesnika - mokraćna kiselina kod kardiohirurških bolesnika

Introduction: The connection between serum uric acid (SUA) and the occurrence of cardiovascular diseases has long been known. Despite the SYNTAX score emerging as useful for risk identification and stratification in the clinical practice of interventional cardiology, it has not been proven useful in cardiac surgical clinical practice. The aim of the paper is to examine the significance of SUA levels, the significance of the SYNTAX score and the Clinical SYNTAX score in predicting the long-term survival of cardiac surgery patients. Methods: A retrospective analysis of 160 cardiac surgery patients operated on between 2013 and 2014 was conducted. SUA, SYNTAX and clinical SYNTAX score was measured. In the follow-up period of 3 years, clinical outcomes of patients were tracked. Results: The average SYNTAX score was 25.2 ± 11.4, the average Clinical SYNTAX score was 26.9 ± 8.3. The average preoperative SUA level was 361 ± 94.1 mg/ dL. No statistically significant difference was found in the values of the ejection fraction, end-diastolic and end-systolic dimensions of the left ventricle in relation to the treatment outcome in the long-term follow-up (p > 0.05). Preoperative left atrial diameter was significantly higher in deceased patients (p = 0.013). No statistically significant difference was found in the average values of the syntax score in relation to the treatment outcome in the long-term follow-up (p = 0.388), while a statistically significant difference was found in the values of the clinical SYNTAX score (p = 0.029). A statistically significant difference was found in the preoperative values of SUA in relation to the postoperative occurrence of adverse cardiovascular events (p = 0.035). Conclusion: Significant predictors of mortality in the long-term follow-up of cardiac surgery patients were left atrial diameter and clinical SYNTAX score. Predictors of adverse cardiovascular outcomes were left atrial diameter, clinical SYNTAX score and preoperative serum uric acid level.

Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study

BackgroundPostoperative delirium (POD) is a common complication after hip fracture surgery that is associated with various short- and long-term outcomes. The mechanism of POD may be associated with the oxidative stress process. Uric acid has been shown to provide a neuroprotective effect in various neurodegenerative diseases through its antioxidant properties. However, it is unclear whether lower preoperative serum uric acid levels are associated with the development of POD after hip fracture surgery. Therefore, this study assessed the association of lower preoperative uric acid levels in patients with POD during hospitalization.MethodsThis is a matched retrospective case-control study that included 96 older patients (≥65 y) who underwent hip fracture surgery. POD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients diagnosed with POD (cases) were matched 1:1 with patients without POD (controls) on the basis of age, sex, and anesthesia type. The relationship between preoperative uric acid and POD was analyzed by multivariable analysis.ResultsThe POD and non-POD groups each had 48 patients. In the univariate analysis, lower log preoperative serum uric acid value, higher neutrophil-to-lymphocyte ratio, and cerebrovascular disease were more likely in patients with POD than in those with no POD. Multivariable conditional logistic regression analysis showed that lower log preoperative serum uric acid (adjusted odds ratio [aOR], 0.028; confidence interval [CI], 0.001–0.844; p = 0.040), higher neutrophil-to-lymphocyte ratio (aOR, 1.314; 95% CI, 1.053–1.638; p = 0.015), and increased surgery duration (aOR, 1.034; 95% CI, 1.004–1.065; p = 0.024) were associated with increased risk of POD.ConclusionsLower preoperative serum uric acid levels may be an independent risk factor for POD after adjustment for possible confounding factors. However, large prospective studies are needed to confirm this finding.

Potential Value of Serum Uric Acid in the Identification of Postoperative Delirium in Geriatric Patients Undergoing Knee Replacement.

ObjectivesThe relationship between preoperative serum uric acid (SUA) and cerebrospinal fluid (CSF) Alzheimer-related biomarkers were investigated to determine whether high SUA is a potential risk factor for postoperative delirium (POD) and to evaluate its predictive efficacy.MethodsThe participants were selected from the Perioperative Neurocognitive Disorder Risk Factor and Prognosis (PNDRFAP) study and the Perioperative Neurocognitive Disorder and Biomarker Lifestyle (PNDABLE) study. The logistic regression equation was used to analyze the risk factors and protective factors of POD. The interaction term (SUA × Sex) was introduced into the linear model to explore the potential modification effects of sex on the identified correlations. We analyzed the mediating effects of Alzheimer-related biomarkers. Finally, we constructed the receiver operating characteristic (ROC) curve and the nomogram model to evaluate the efficacy of SUA and Alzheimer-related biomarkers in predicting POD.ResultsPatients with POD had elevated SUA level (PNDRFAP: p = 0.002, PNDABLE: p < 0.001). Preoperative SUA level was positively correlated with CSF phosphorylated tau (P-tau) (p = 0.027) and β-amyloid42 (Aβ42)/P-tau (p = 0.023). Interaction analysis did not find any modification effect of sex. The relationship between SUA and POD was partially mediated by CSF P-tau (15.3%). ROC curve showed that the model combining SUA and Alzheimer-related biomarkers had better performance in predicting POD [area under the curve (AUC) = 0.880; p < 0.001], and the predictive model is accurate.ConclusionsHigh SUA may enhance CSF P-tau level, thus increasing the risk of POD, and the model combining SUA and Alzheimer-related biomarkers can accurately predict the occurrence of POD.

Correlation between Serum Oxidative Stress Level and Serum Uric Acid and Prognosis in Patients with Hepatitis B-Related Liver Cancer before Operation

Aiming to explore the correlation between preoperative serum oxidative stress level and serum uric acid and prognosis of hepatitis B-related liver cancer, the clinical data of 712 patients with hepatitis B-related liver cancer from January 2019 to December 2020 were retrospectively analyzed. By using the receiver operating curve, the optimal critical values of preoperative superoxide dismutase (SOD), malondialdehyde (MDA), and serum uric acid (SUA) are determined. The single-factor and multifactor Cox models are applied to screen out the suspicious factors affecting the prognosis of patients with hepatitis B-related liver cancer. According to the survival status of patients, the optimal thresholds of SOD, MDA, and SUA before operation were 58.055/mL, 10.825 nmol/L, and 312.77 nmol/L, respectively. The results of univariate analysis show that the prognosis of patients is significantly correlated with preoperative SOD, MDA, and SUA levels and TNM staging (P < 0.05). Additionally, multivariate analysis demonstrates that preoperative SOD < 58.055 U/mL and SUA ≥ 312.770 mmol/L and TNM stage III-IV are independent risk factors for postoperative prognosis (P < 0.05). Our study suggests that SOD, SUA, and TNM staging have certain value in judging the early prognosis of patients with hepatitis B-related liver cancer. Patients with high preoperative SOD level and low preoperative SUA level can obtain better prognosis.

Long-term impact of baseline serum uric acid levels on living kidney donors: a retrospective study

BackgroundPreoperative characteristics of living kidney donors are commonly considered during donor selection and postoperative follow-up. However, the impact of preoperative uric acid (UA) levels is poorly documented. The aim of this study was to evaluate the association between preoperative serum UA levels and post-donation long-term events and renal function.MethodsThis was a single-center retrospective analysis of 183 living kidney donors. The donors were divided into high (≥5.5 mg/dl) and low (< 5.5 mg/dl) UA groups. We analyzed the relationship between preoperative UA levels and postoperative estimated glomerular filtration rate (eGFR), as well as adverse events (cardiovascular events and additional prescriptions for hypertension, gout, dyslipidemia, and diabetes mellitus), over 5 years after donation.ResultsIn total, 44 donors experienced 52 adverse events over 5 years. The incidence of adverse events within 5 years was significantly higher in the high UA group than in the low UA group (50% vs. 24%, p = 0.003); this was true even after the exclusion of hyperuricemia-related events (p = 0.047). UA emerged as an independent risk factor for adverse events (p = 0.012). Donors with higher UA levels had lower eGFRs after donation, whereas body mass index, hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol did not have any impact on the eGFR.ConclusionsThe findings suggest that preoperative UA levels should be considered during donor selection and postoperative follow-up.

The relationship between serum uric acid levels and development of obesity in living kidney donors after donor nephrectomy.

Hyperuricaemia plays a role in the pathogenesis of obesity and related metabolic disorders. The aim of this study to investigate the relationship between pre-donation serum uric acid (SUA) level and obesity development after nephrectomy in living kidney donors. Living donors of kidney transplants between 1998 and 2019 were evaluated. Donors with less than 1year of follow-up were excluded from the study. The participants were divided into two groups according to last control body mass index (BMI) (obese; ≥30kg/m2 and nonobese; <30kg/m2 ) and median baseline SUA level (<4.6mg/dL and ≥4.6mg/dL). In the included 240 donors, the mean follow-up was 50±44 (12-216) months. The mean age was 47±11 (19-82) years, and 46.6% of donors were male. At last control, the percentage of obese donors had increased significantly compared to pre-donation time (22.5% vs 33.8%; P<.001) and last control obese donors had both higher baseline SUA (5.1±1.4 vs 4.5±1.2; P<.01) and BMI (30.7±2.6 vs 24.8±3.0; P<.001). Cox regression analysis showed that there is an independent relationship between the baseline SUA level and development of obesity (odds ratio: 1.30 [CI; 1.12-1.50]; P<.001). In Kaplan-Meier analysis, the development of obesity was significantly higher in kidney donors with high SUA level. Living kidney donors (LKD) have a tendency to obesity after nephrectomy. Preoperative serum uric acid level gives important information in LKDs that it could foresee the development of obesity after donation.

Relationship of Preoperative Serum Uric Acid Level with Survival in Colorectal Cancer

To investigate the prognostic significance of uric acid level in colorectal cancer in addition to conventional factors in terms of survival. Observational Study. At the University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, between January 2012 and December 2019. Methodology: A total of selected 332 patients, who underwent surgery for colorectal cancer between 2012 and 2019, were retrospectively reviewed. Patients with a history of neoadjuvant therapy due to rectal cancer, GUT disease, renal failure, stage 4 disease, emergency surgery and severe preoperative infection, were excluded from the study. Peripheral blood samples were collected about a week before the operation. Serum uric acid (SUA) values were measured and recorded. Results: The patients comprised 198 males and 134 females with a mean age 62.2 ±11.7 years (14-91) years in total. Conventional surgery was performed in 228 patients, and laparoscopy in 104 patients. Uric acid level, number of pathological lymph nodes, number of pathological lymph nodes/total number of lymph nodes (LNO), perineural invasion, type of surgery and disease stage were found to be factors affecting the prognosis (p <0.05). Uric acid cut off value of 5.3 or higher was found to be statistically significant in terms of survival. Serum uric acid (SUA) value measured preoperatively was found to be a prognostic factor for colorectal cancer. Key Words: Serum uric acid (SUA), Colon cancer, Rectal cancer, Prognostic factor.

Effect of hyperuricemia on functional outcomes and complications in patients with elbow stiffness after open arthrolysis combined with hinged external fixation: a retrospective study

Hyperuricemia is considered a risk factor for increased postoperative complications and adverse functional outcomes in a variety of orthopedic surgeries. The purpose of this retrospective study was to investigate the clinical efficacy of patients with different uric acid levels after elbow arthrolysis. The study included 131 patients with post-traumatic elbow stiffness who underwent arthrolysis between March 2014 and March 2016. All patients were divided into 4 groups based on the preoperative serum level of uric acid (UA). The quartile method was used for grouping patients, including 33 in Q1 (UA <293 μmol/L), 34 in Q2 (293-348 μmol/L), 32 in Q3 (348-441 μmol/L), and 32 in Q4 (441-710 μmol/L). At baseline and each time point of follow-up, functional performance, Mayo Elbow Performance Score, visual analog scalefor pain, and complications were evaluated. Preoperative data were not significantly different among the 4 groups (Q1, Q2, Q3, and Q4). At the final follow-up, the following data showed significant differences among the 4 groups: extension (P = .031), flexion (P = .008), range of motion(P = .003), Mayo Elbow Performance Score (P = .011), and visual analog scale (P = .032). Interestingly, patients in the Q4 group had the poorest clinical outcomes. However, no significant differences were found among the 4 groups in new onset or exacerbation of nerve symptoms (P = .919), reduced muscle strength (P = .536), instability (P = .567), or infection (P = .374) at the last follow-up. This study confirms that in patients with post-traumatic elbow stiffness, abnormal serum uric acid metabolism was a risk factor for poor performance and postoperative pain after arthrolysis. Therefore, detecting the preoperative serum uric acid levels of the patients would be helpful for evaluating the postoperative outcomes.

Impact of bariatric surgery on serum uric acid levels and the incidence of gout-A meta-analysis.

Gout is characterized by high serum uric acid (SUA) levels and arthritis. It is associated with obesity and metabolic syndrome. Bariatric surgery has been associated with decreased SUA levels and overall gout incidence. This meta-analysis aims to summarize the current evidence on bariatric surgery, gout and SUA levels. A literature review was performed on papers published from 2000 up till December 2018. Original studies investigating the impact of bariatric surgery on SUA levels or gout incidence were evaluated. Twenty studies with a total of 5,233 patients were analysed. Majority (n=14) had a follow-up duration of at least 12 months. The mean preoperative body mass index (BMI) was 45.2kg m-2 . The mean preoperative SUA level was 6.5mg dL-1 . Subgroup analysis demonstrated a mean decrease in SUA levels (-0.73mg dL-1 ) from the third postoperative month onwards, which was sustained until the third postoperative year (-1.91mg dL-1 ). There was a rise in SUA levels in the first post-operative month. Meta-regression analyses demonstrated a proportionate linear relationship between the change in BMI and SUA levels. Post-bariatric surgery weight loss is associated with reduced SUA levels and decreased incidence of gout attacks. However, this is only evident from the third post-operative month onwards.

Pre-donation BMI and preserved kidney volume can predict the cohort with unfavorable renal functional compensation at 1-year after kidney donation

BackgroundThe magnitude of renal function recovery after kidney donation differs in donors with a heterogeneous background. Preoperative assessment of candidates with potentially unfavorable renal functional compensation is critical when baseline kidney function is marginal. We explored the significance of preserved kidney volume (PKV) and known preoperative risk factors for the prediction of unfavorable renal function compensation.MethodsWe enrolled 101 living donors for whom a 1-mm sliced enhanced computed tomography scan was performed preoperatively and clinical data could be collected up to 1 year after donation. The donors whose estimated glomerular filtration rate (eGFR) at 1 year after donation was 70% or higher of baseline eGFR were assigned to the “favorable renal compensation” group and the others to the “unfavorable renal compensation” group.ResultsAge, sex, and preoperative serum uric acid level were not significant predictors for “unfavorable renal compensation.” Multivariable logistic regression analysis revealed that body mass index (BMI) and body surface area (BSA)-adjusted PKV were independent preoperative risk factors for “unfavorable renal compensation” (adjusted odds ratio, 1.342 and 0.929, respectively). Hypertension and preoperative eGFR were not independent predictors when adjusted with BMI and BSA-adjusted PKV. Receiver operative characteristic analysis revealed that the predictive equation with the two independent predictors yielded a good accuracy to detect donor candidates with unfavorable renal functional compensation (area under the curve = 0.803), and the optimal cut-off values were identified as 23.4 kg/m2 for BMI and 107.3 cm3/m2 for BSA-adjusted PKV.ConclusionsBMI and BSA-adjusted PKV may be useful to select candidates with potentially unfavorable renal function compensation before kidney donation.

Risk factors for acute kidney injury after percutaneous nephrolithotomy: Implications of intraoperative hypotension.

Percutaneous nephrolithotomy (PNL) is a minimally invasive technique for renal stone removal but can cause renal parenchymal injury. Renal stones can also affect renal function. We evaluated the risk factors for acute kidney injury (AKI) after PNL.The study cohort included 662 patients who underwent PNL. Patient characteristics, preoperative laboratory values, intraoperative data, and stone characteristics were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for AKI after PNL. Postoperative outcomes such as hospitalization, intensive care unit admission rate and stay duration, and chronic kidney disease were also evaluated.Of the total study series, there were 107 (16.2%) cases of AKI after PNL (AKI group), and 555 (83.8%) patients who showed no injury (no-AKI group). The risk factors for AKI after PNL were found to be a higher preoperative serum uric acid level [odds ratio (OR) = 1.228; 95% confidence interval (95% CI) = 1.065–1.415; P = .005], longer operation time (OR = 1.009; 95% CI = 1.004–1.014; P < .001), and intraoperative hypotension (OR = 12.713; 95% CI = 7.762–20.823; P < .001). Hospitalization and intensive care unit stay duration were significantly longer in the AKI group (8.7 ± 5.2 vs 6.6 ± 2.8 days, P < .001; 0.34 ± 1.74 vs 0.07 ± 0.48 days, P = .002, respectively). Chronic kidney disease was also significantly higher in the AKI group (63.6% vs 32.7%, P = .024).As intraoperative hypotension is an important risk factor for AKI after PNL, which leads to poor postoperative outcomes, it should be prevented or managed vigorously during PNL.

Association of asymptomatic hyperuricemia with mortality in patients undergoing elective percutaneous coronary intervention

Objective: This study investigated the influence of asymptomatic hyperuricemia on the prognosis of patients who had undergone elective percutaneous coronary intervention (PCI). Methods: A total of 3 452 consecutive patients , who had preoperative serum uric acid level record and were without gout, underwent elective PCIs between July 2009 and September 2011 were included in this study. Patients were divided into two groups based on their preoperative serum uric acid levels. The association between baseline serum uric acid levels and postoperative mortality was investigated through 1.5 years of follow up. Results: Of the 3 452 patients in the study population, 516 had elevated uric acid and 2 936 had normal uric acid.Patients in the elevated uric acid group were older, more frequently had prior history of hypertension, stroke, myocardial infarction and interventional procedure, less likely to have prior history of diabetes mellitus.Other significant differences included higher white blood cell, total cholesterol and triglyceride levels; lower left ventricular ejection fraction, estimated glomerular filtration rate and high density lipoprotein (HDL) levels, more companied by multivessel disease, more PCI lesions, lower complete revascularization rate.More patients with elevated uric acid level were treated with ACEI/ARB and diuretics at the time of hospital discharge.The results of a multivariate Cox regression analysis revealed that preoperative elevated uric acid was an independent predictive factor for mortality after adjustment for other factors (hazard ratio 3.252, 95% confidence interval 1.902-5.560, P<0.001). Conclusion: Asymptomatic hyperuricemia is an independent predictive factor of mortality in patients undergoing elective PCI.

Abstract B27: Serum uric acid levels as a prognostic factor in male patients with non-metastatic colorectal cancer

Abstract Objective: Uric acid may be a marker of oxidative stress, and can be act as an antioxidant or a prooxidant. The role of serum uric acid (SUA) in the prognostic impact of cancer is controversial. This study aimed to evaluate whether the preoperative SUA level is associated with long-term outcomes in patients with colorectal cancer (CRC). Methods: Between 2002 and 2010, 2,183 patients, who underwent curative surgical resection for non-metastatic CRC and had available SUA value, were included for this study. We analyzed the association between the overall survival (OS) and SUA level as quartile according to sex, using log-rank test and Cox proportional hazard regression to identify prognostic factors. Results: Mean SUA level was different between male and female (male [n=1,328]: 5.320 ± 1.363, female [n=855]: 4.065 ± 1.180, p&amp;lt;0.001). In female patients, there was no difference in OS according to SUA level. In male patients, SUA levels in the lowest quartile (&amp;lt; 3.5 mg/dL) was associated with poor overall survival (5-year OS of SUA level &amp;lt; 3.5 mg/dL vs ≥ 3.5 mg/dL: 72.0 % vs 97.1 %, p &amp;lt; 0.001). SUA level was an independently significant prognostic factor (HR 1.714, 95% CI 1.306-2.250, p&amp;lt;0.001). Conclusion: Our results do not support the protective role of SUA in CRC cancer, and rather lower SUA concentrations to be associated with poor long-term outcomes in male CRC patients. Citation Format: Shin Rumi, Park Ji Won, Lee Dong Woon, Ryoo Seung-Bum, Jeong Seung-Yong. Serum uric acid levels as a prognostic factor in male patients with non-metastatic colorectal cancer. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr B27.

Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis

BackgroundMounting evidence indicated that the elevated serum uric acid level was associated with an increased risk of acute kidney injury (AKI). Our goal was to systematically evaluate the correlation of serum uric acid (SUA) level and incidence of AKI by longitudinal cohort studies.MethodsWe searched electronic databases and the reference lists of relevant articles. 18 cohort studies with 75,200 patients were analyzed in this random-effect meta-analysis. Hyperuricemia was defined as SUA levels greater than 360-420 μmol/L (6–7 mg/dl), which was various according to different studies. Data including serum uric acid, serum creatinine, and incidence of AKI and hospital mortality were summarized using random-effects meta-analysis.ResultsThe hyperuricemia group significantly exerted a higher risk of AKI compared to the controls (odds ratio OR 2.24, 95% CI 1.76-2.86, p < 0.01). Furthermore, there is less difference of the pooled rate of AKI after cardiac surgery between hyperuricemia and control group (34.3% vs 29.7%, OR 1.24, 95% CI 0.96-1.60, p = 0.10), while the rates after PCI were much higher in hyperuricemia group than that in control group (16.0% vs 5.3%, OR 3.24, 95% CI 1.93-5.45, p < 0.01). In addition, there were significant differences in baseline renal function at admission between hyperuricemia and control groups in most of the included studies. The relationship between hyperuricemia and hospital mortality was not significant. The pooled pre-operative SUA levels were higher in AKI group than that in the non-AKI group.ConclusionsElevated SUA level showed an increased risk for AKI in patients and measurements of SUA may help identify risks for AKI in these patients.

Prognostic value of pre-operative serum uric acid levels in esophageal squamous cell carcinoma patients who undergo R0 esophagectomy.

The serum uric acid (SUA) is the end-product from the metabolic breakdown of purine nucleotides. It has been considered to be a prognostic factor for malignant tumor in several researches. However, its prognostic value in patients with esophageal squamous cell carcinoma (ESCC) has not been elucidated. We retrospectively reviewed the records of 209 ESCC patients who underwent R0 esophagectomy. A receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value for pre-operative SUA levels and to divide the ESCC patients into two groups. Furthermore, we analyzed the pre-operative serum uric acid (SUA) levels and its relationship with the clinicopathological parameters and the prognosis of 209 ESCC patients. Optimal cut-off value for pre-operative SUA in ROC analysis was 304.5 μ mol/l (sensitivity 67.46%, specificity 65.06%). SUA low- or high-levels were associated with gender (P< 0.001), smoking status (P< 0.001), pN statues (P= 0.003) and TNM stage (P= 0.010). SUA levels, tumor differentiation and pTNM stage were independent predictors of ESCC patient survival in a multivariate analysis. The pre-operative level of SUA is an independent prognostic predictor in ESCC patients who undergo R0 esophagectomy and patients with higher SUA level may have an unfavorable survival probability.

Incidence and Risk Factors of Acute Kidney Injury after Radical Cystectomy: Importance of Preoperative Serum Uric Acid Level.

Background: Acute kidney injury (AKI) is a common complication after surgery and increases costs, morbidity, and mortality of hospitalized patients. While radical cystectomy associates significantly with an increased risk of serious complications, including AKI, risk factors of AKI after radical cystectomy has not been reported. This study was performed to determine the incidence and independent predictors of AKI after radical cystectomy.Methods: All consecutive patients who underwent radical cystectomy in 2001-2013 in a single tertiary-care center were identified. Their demographics, laboratory values, and intraoperative data were recorded. Postoperative AKI was defined and staged according to the Acute Kidney Injury Network criteria on the basis of postoperative changes in creatinine levels. Independent predictors of AKI were identified by univariate and multivariate logistic regression analyses.Results: Of the 238 patients who met the eligibility criteria, 91 (38.2%) developed AKI. Univariate logistic regression analyses showed that male gender, high serum uric acid level, and long operation time associated with the development of AKI. On multivariate logistic regression analysis, preoperative serum uric acid concentration (odds ratio [OR] = 1.251; 95% confidence interval [CI] = 1.048-1.493; P = 0.013) and operation time (OR = 1.005; 95% CI = 1.002-1.008; P = 0.003) remained as independent predictors of AKI after radical cystectomy.Conclusions: AKI after radical cystectomy was a relatively common complication. Its independent risk factors were high preoperative serum uric acid concentration and long operation time. These observations can help to prevent AKI after radical cystectomy.

Uric acid levels in blood are associated with clinical outcome in soft-tissue sarcoma patients

Recent evidence indicates toward a role of uric acid (UA) as a potential antioxidant. Elevated UA levels were shown to be associated with better survival in various malignancies. The aim of the present study was to evaluate the prognostic relevance of pre-operative UA levels on cancer-specific survival (CSS) in soft-tissue sarcoma (STS) patients who underwent curative surgical resection. Three hundred and fifty-seven patients with STS were included in the study. Pre-operative serum UA level was measured using an enzymatic colorimetric assay. The effect of UA levels on CSS was analyzed using Kaplan-Meier curves. To further evaluate the prognostic impact of UA levels, univariate and multivariate Cox proportional models were calculated. Among the 357 STS patients, cancer-related deaths occurred in 20 (24.7%) of 81 patients with a serum UA level <279.6 µmol/L and in 36 (13%) of 276 patients with a UA level ≥279.6 µmol/L. In univariate analysis, elevated UA levels were significantly associated with increased CSS in STS patients [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.26-0.77, p=0.004]. Furthermore, elevated UA levels remain a significant factor for better CCS in multivariate analysis (HR 0.42, 95% CI 0.23-0.75, p=0.003). Our study is the first one to demonstrate that higher UA levels are associated with positive clinical outcome in STS patients. UA levels are a simple and cost-effective test for the assessment of the prognosis of STS patients.