[Prognostic nutritional index and risk of incident hyperuricemia: A retrospective cohort study]

The prognostic nutritional index (PNI) is a composite indicator reflecting nutritional and immune status; however, its association with incident hyperuricemia (HUA) remains unclear. This large-scale retrospective cohort study aims to investigate the relationship between PNI and the risk of developing HUA, providing evidence for early screening and nutritional intervention strategies.

A total of 22 551 individuals who underwent baseline health examinations in 2012 were included. Participants were categorized into quartiles according to PNI levels (Q1, <52.4; Q2, 52.4-<55.1; Q3, 55.1-<57.9; Q4, ≥57.9). Cox proportional hazards models were used to evaluate the association between PNI and incident HUA, with progressive adjustment for age, sex, body mass index (BMI), hypertension, diabetes, dyslipidemia, and renal function. Using Q1 as the reference group, hazard ratios (HR) for Q2-Q4 were estimated. Restricted cubic spline models were applied to assess the dose-response relationship between continuous PNI and HUA risk. Additionally, Q1-Q3 were combined as the low-PNI group (PNI<57.9) and Q4 as the high-PNI group (PNI≥57.9) for subgroup analyses and interaction testing.

The numbers of participants in Q1-Q4 were 5 468, 5 658, 5 680, and 5 745, respectively. During a median follow-up of 10.5 years, 5 247 incident HUA cases were identified. In the fully adjusted model, participants in Q4 had an 18.4% higher risk of HUA compared with Q1 [HR=1.184, 95% confidence interval (CI) 1.089 to 1.287, P<0.001]. When treated as a continuous variable, each 1-unit increase in PNI was associated with a 1.4% increase in HUA risk (HR=1.014, 95% CI 1.007 to 1.020, P<0.001), demonstrating a significant dose-response relationship (P_trend<0.001). Restricted cubic spline analysis indicated a linear positive association between PNI and HUA risk after full adjustment (P_trend<0.05). Subgroup analysis revealed that the high-PNI group had a 16.2% higher risk of HUA compared with the low-PNI group (HR=1.162, 95% CI 1.092 to 1.237, P<0.001); however, this association was attenuated among individuals with hypertension (P_interaction=0.010).

Elevated PNI (≥57.9) is an independent risk factor for incident HUA in a general health examination population, and this association is significantly modified by hypertension status. As a readily available composite marker, PNI may facilitate early identification of individuals at high risk for HUA and support personalized screening and intervention strategies.