Hyperuricemia is a prognostic marker for antiphospholipid syndrome patients: a retrospective cohort study in China

Hyperuricemia (HUA) is implicated in inflammation and a prothrombotic state, but its prognostic role in antiphospholipid syndrome (APS) remains uncertain. This study aims to evaluate the prognostic value of HUA in APS and identify optimal serum uric acid (SUA) thresholds for predicting adverse outcomes.

All patients fulfilled the 2006 Sydney criteria for APS were followed up at Peking University People's Hospital (2009-2022). Patients with persistent HUA were included in the HUA group. Comparative analyses were conducted between APS patients with and without HUA. Subgroup and ROC analyses were performed to evaluate prognostic value and identify optimal SUA thresholds.

Among 240 primary APS patients, 45 (18.8%) had HUA. APS patients with HUA had a significantly higher 10-year cumulative all-cause mortality (60.8% vs. 6.6%, P = 0.002), APS-related mortality (45.2% vs. 2.0%, P = 0.004), and thrombosis recurrence rates (40.3% vs. 17.2%, P = 0.005). Multivariate Cox mortality analysis showed that HUA was significantly associated with 10-year cumulative all-cause mortality (HR = 6.408, P = 0.010), APS-related mortality (HR = 15.409, P = 0.031), and thrombosis recurrence rates (HR = 3.227, P = 0.014). SUA thresholds predicting all-cause mortality (8.7 mg/dL, OR = 44.121, P < 0.001) and thrombosis recurrence (5.6 mg/dL, OR = 4.145, P = 0.004) were identified.

HUA is associated with a higher risk of adverse outcomes in APS patients. SUA thresholds of 8.7 mg/dL and 5.6 mg/dL may serve as predictors of mortality and thrombotic recurrence, providing potential insights for risk stratification and management in APS. Key Points • APS patients with HUA have higher 10-year cumulative mortality and thrombotic recurrence rates. • HUA may serve as a prognostic marker for APS patients. • SUA thresholds of 8.7 mg/dL and 5.6 mg/dL may serve as predictors of mortality and thrombotic recurrence. • Our observations remind clinicians to focus on APS patients with HUA, and adopt appropriate strategies to reduce the recurrence of thrombosis and mortality.