Seda TURAL ONUR, Fatma TOKGÖZ AKYIL, Sinem Nedime SOKUCU, Dilara DEMİR, Neslihan BOYRACI, Hülya ABALI

Kronik Obstrüktif Akciğer Hastalığının Akut Alevlenmesinde Ürik Asit ve Ürik Asitin Kreatinine Oranı Mortalitenin Öngörücüleri midir?

Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) klinik seyrinde, kötü prognoza neden olan, ek tedavi gerektiren, solunum semptomlarında (dispne, öksürük, balgam) kötüleşme olarak tanımlanan alevlenmeler gözlenebilir. Maliyet-etkin mortalite öngörücüleri, KOAH’ın tedavi yönetimi için değerlidir. Akut KOAH alevlenmeleri olan serum ürik asit (ÜA) ve serum ürik asitin kreatinine oranının (ÜKO) mortalite ve hipoksemi için belirleyici olup olmadığını araştırmayı amaçladık. Gereç ve Yöntemler: Bu gözlemsel kesitsel çalışmada, Ocak 2014 ile Aralık 2018 arasında bir referans göğüs hastanesinde yatan 105 KOAH alevlenmesindeki hasta retrospektif olarak değerlendirildi. ÜA ve ÜKO ile uzun vadeli mortalite, hipoksemi, komorbidite, FEV1 değeri, KOAH’ın tanı, tedavi ve önlenmesi için küresel strateji (GOLD) evreleri arasındaki ilişkiler analiz edildi. Bulgular: KOAH alevlenmesindeki toplam 105 hastayı (97’si erkek, ortalama yaş 65±9 yıl) içeren bu çalışmada hiperürisemi ile mortalite arasında anlamlı bir korelasyon bulunurken (sırasıyla, p=0.027; p=0.016), ÜKO ile mortalite arasında korelasyon bulunmadı (sırasıyla, p=0.051, p=0.053). Düşük ÜA seviyesi hipoksemi ile anlamlı olarak ilişkiliydi (p=0.022), ancak ÜKO ile hipoksemi arasında bir ilişki gözlen- medi (p=0.094). Sonuç: KOAH alevlenmesindeki hastaların uzun vadeli mortalitesini öngörmede serum ÜA’nin ÜKO’na göre daha değerli olduğu görülmektedir. Sık klinik takip ve yoğun tedavi yönetimi gerektiren yüksek riskli KOAH hastalarının tanımlanması için serum ÜA’in uzun vadeli mortalitenin biyobelirteci olarak kullanılabileceğini öneriyoruz.

Are Uric Acid and Uric Acid Creatinine Ratio Predictors for Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Aim: In the clinical course of Chronic Obstructive Pulmonary Disease (COPD), exacerbations that are defined as worsening of respiratory symptoms (dyspnoea, cough, sputum production) may occur, which causes poor prognosis and require additional treatments. Cost-effective mortality predictors are valuable for the treatment management of COPD. We aimed to investigate whether serum uric acid (UA) and serum uric acid to creatinine ratio (UCR) are predictors of mortality and hypoxemia in patients with acute exacerbations of COPD (AECOPD). Material and Methods: 105 patients with AECOPD who were hospitalized in a reference chest hospital between January 2014 and December 2018 were evaluated retrospectively in this cross-sectional study. The associations between UA and UCR and long-term mortality, hypoxemia, comorbidity, FEV1 value, and Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) stage were analyzed. Results: In the present study including 105 patients with AECOPD (97 males, mean age of 65±9 years), a significant correlation was found between hyperuricemia and mortality (95% CI:1.15-10.72, p=0.027; 95% CI:1.16-4.12, p=0.016, respectively), while no correlation was found between UCR and mortality (p=0.051, p=0.053, respectively). Low UA level was associated with hypoxemia significantly (p=0.022), but no association was observed between UCR and hypoxemia (p=0.094). Conclusion: It appears that UA is more important for predicting long-term mortality in patients with AECOPD than UCR. We suggest that UA can be used as a biomarker of long-term mortality for the identification of high-risk COPD patients that require frequent clinical follow-up and intense treatment management.

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