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Serum Uric Acid as a Biomarker of Disease Severity in Scleroderma Patients with Pulmonary Arterial Hypertension
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A2111 - Serum Uric Acid as a Biomarker of Disease Severity in Scleroderma Patients with Pulmonary Arterial Hypertension
Author Block: C. Simpson1, D. E. Amariei2, R. Khair3, T. M. Kolb4, P. M. Hassoun5, R. L. Damico6, S. C. Mathai7; 1Pulmonary Division, Johns Hopkins University, Baltimore, MD, United States, 2University of Maryland, Baltimore, MD, United States, 3Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 4Johns Hopkins, Baltimore, MD, United States, 5Div of Pulm and Crit Care, Johns Hopkins Univ School of Med, Baltimore, MD, United States, 6Johns Hopkins Univ, Baltimore, MD, United States, 7John Hopkins School of Med, Baltimore, MD, United States.
RATIONALE: Previous work by our group has shown that serum uric acid (UA) is significantly higher in patients with systemic sclerosis (SSc) complicated by pulmonary arterial hypertension (PAH) than in SSc patients without PAH, an observation that holds true when adjusted for age, sex, and renal function. Given that reliable and easily obtained predictors of outcomes in patients with SSc-PAH are lacking, we sought to determine the relationship between UA and disease severity.
METHODS: Consecutive SSc patients referred to our center for evaluation of dyspnea and found to have PAH on right heart catheterization (RHC) were included. Subjects with significant obstructive or restrictive lung disease were excluded. Spearman correlation coefficients were used to assess relationships between UA and serum markers of disease severity, functional capacity, and resting hemodynamics. The association between baseline UA and survival was assessed using Cox proportional hazard modeling.
RESULTS: 60 subjects diagnosed with PAH based on RHC were included. On average, subjects were 64±12 years of age; most were women (86%) with limited scleroderma and WHO functional class III symptoms. The median value of UA in the overall cohort was 7.3mg/dL. Serum UA correlated positively with proBNP (r=0.30, p=0.03), creatinine (r=0.50, p=0.001), mean pulmonary artery pressure (mPAP, r=0.45, p=0.004) and pulmonary vascular resistance (PVR, r=0.39, p=0.003), but was not significantly associated with six-minute walk distance, cardiac output, or cardiac index. Serum UA was associated with a trend toward increased risk of death (HR 1.44, 95% CI 0.98-2.11, p=0.16) after adjusting for age, sex, and eGFR.
CONCLUSIONS: Our results show that in this cohort of incident SSc-PAH patients, serum UA is correlated with markers of disease severity. Further, baseline UA is associated with survival, though results did not reach statistical significance. Taken together, these results suggest that UA has the potential to serve as a novel biomarker for disease severity in patients with SSc-PAH.
Author Block: C. Simpson1, D. E. Amariei2, R. Khair3, T. M. Kolb4, P. M. Hassoun5, R. L. Damico6, S. C. Mathai7; 1Pulmonary Division, Johns Hopkins University, Baltimore, MD, United States, 2University of Maryland, Baltimore, MD, United States, 3Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 4Johns Hopkins, Baltimore, MD, United States, 5Div of Pulm and Crit Care, Johns Hopkins Univ School of Med, Baltimore, MD, United States, 6Johns Hopkins Univ, Baltimore, MD, United States, 7John Hopkins School of Med, Baltimore, MD, United States.
RATIONALE: Previous work by our group has shown that serum uric acid (UA) is significantly higher in patients with systemic sclerosis (SSc) complicated by pulmonary arterial hypertension (PAH) than in SSc patients without PAH, an observation that holds true when adjusted for age, sex, and renal function. Given that reliable and easily obtained predictors of outcomes in patients with SSc-PAH are lacking, we sought to determine the relationship between UA and disease severity.
METHODS: Consecutive SSc patients referred to our center for evaluation of dyspnea and found to have PAH on right heart catheterization (RHC) were included. Subjects with significant obstructive or restrictive lung disease were excluded. Spearman correlation coefficients were used to assess relationships between UA and serum markers of disease severity, functional capacity, and resting hemodynamics. The association between baseline UA and survival was assessed using Cox proportional hazard modeling.
RESULTS: 60 subjects diagnosed with PAH based on RHC were included. On average, subjects were 64±12 years of age; most were women (86%) with limited scleroderma and WHO functional class III symptoms. The median value of UA in the overall cohort was 7.3mg/dL. Serum UA correlated positively with proBNP (r=0.30, p=0.03), creatinine (r=0.50, p=0.001), mean pulmonary artery pressure (mPAP, r=0.45, p=0.004) and pulmonary vascular resistance (PVR, r=0.39, p=0.003), but was not significantly associated with six-minute walk distance, cardiac output, or cardiac index. Serum UA was associated with a trend toward increased risk of death (HR 1.44, 95% CI 0.98-2.11, p=0.16) after adjusting for age, sex, and eGFR.
CONCLUSIONS: Our results show that in this cohort of incident SSc-PAH patients, serum UA is correlated with markers of disease severity. Further, baseline UA is associated with survival, though results did not reach statistical significance. Taken together, these results suggest that UA has the potential to serve as a novel biomarker for disease severity in patients with SSc-PAH.
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