Association of hyperuricemia and pulmonary hypertension: A systematic review and meta-analysis

<b>Objectives:</b> To investigate the association of hyperuricemia with pulmonary hypertension (PH) in term of subsequent development, severity, and prognosis of PH. <b>Methods:</b> The authors systematically reviewed articles from databases and conducted meta-analyses as follows: (1) association of serum uric acid (UA) levels with the presence of PH; (2) association between serum UA levels and subsequent development of PH, in terms of odds ratio of the development of PH; and (3) association of serum UA levels with severity and prognosis of PH, in terms of pulmonary arterial pressure and hazard ratio of death. <b>Results:</b> Twenty-six studies published between 1999 and 2017 were included. The level of serum UA was higher in subjects with PH than subjects without PH and this finding was observed regardless of status of diuretics use or renal function. The odds ratio of the development of PH was 2.32 (95% CI, 1.05–5.15) in subjects with hyperuricemia. Pulmonary arterial pressure among subjects with PH was also higher in subjects with hyperuricemia than subjects with normouricemia. There was a 19% increased hazard ratio of death (95% CI, 1.06–1.33) among patients with PH who had hyperuricemia. <b>Conclusion:</b> Hyperuricemia is associated with the subsequent development, worse severity and poor prognosis of PH.

<b>研究目标：</b> 探讨高尿酸血症（hyperuricemia）与肺动脉高压（pulmonary hypertension, PH）之间的关联，具体聚焦于肺动脉高压的后续发生、严重程度及预后。<b>研究方法：</b> 作者系统检索了数据库中的相关文献，并开展了三项荟萃分析，具体如下：(1) 血清尿酸（serum uric acid, UA）水平与肺动脉高压患病情况的关联；(2) 血清尿酸水平与肺动脉高压后续发生的关联，以肺动脉高压发生的比值比（odds ratio）进行衡量；(3) 血清尿酸水平与肺动脉高压严重程度及预后的关联，以肺动脉压及死亡风险比（hazard ratio）进行衡量。<b>研究结果：</b> 本研究共纳入1999年至2017年间发表的26项研究。与非肺动脉高压受试者相比，肺动脉高压受试者的血清尿酸水平更高，且该结果不受利尿剂使用状态或肾功能状况的影响。高尿酸血症受试者发生肺动脉高压的比值比为2.32（95%置信区间：1.05~5.15）。肺动脉高压受试者中，高尿酸血症者的肺动脉压亦高于血尿酸正常受试者。合并高尿酸血症的肺动脉高压患者的死亡风险比升高19%（95%置信区间：1.06~1.33）。<b>研究结论：</b> 高尿酸血症与肺动脉高压的后续发生、更严重的病情及不良预后均存在关联。