{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:06:10Z","timestamp":1760148370212,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T00:00:00Z","timestamp":1682380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Hyperuricemia is a well-known cardiovascular risk factor. The aim of our study was to investigate the connection between postoperative hyperuricemia and poor outcomes after elective cardiac surgery compared to patients without postoperative hyperuricemia. In this retrospective study, a total of 227 patients after elective cardiac surgery were divided into two groups: 42 patients with postoperative hyperuricemia (mean age 65.14 \u00b1 8.9 years) and a second group of 185 patients without it (mean age 62.67 \u00b1 7.45 years). The time spent on mechanical ventilation (hours) and in the intensive care unit (days) were taken as the primary outcome measures while the secondary measure comprised postoperative complications. The preoperative patient characteristics were similar. Most of the patients were men. The EuroSCORE value of assessing the risk was not different between the groups nor the comorbidities. Among the most common comorbidities was hypertension, seen in 66% of all patients (69% in patients with postoperative hyperuricemia and 63.7% in those without it). A group of patients with postoperative hyperuricemia had a prolonged time of treatment in the intensive care unit (p = 0.03), as well as a prolonged duration of mechanical ventilation (p &lt; 0.01) and a significantly higher incidence of the following postoperative complications: circulatory instability and\/or low cardiac output syndrome (LCOS) (\u03c72 = 4486, p &lt; 0.01), renal failure and\/or continuous venovenous hemodiafiltration (CVVHDF\u2019s) (\u03c72 = 10,241, p &lt; 0.001), and mortality (\u03c72 = 5.22, p &lt; 0.01). Compared to patients without postoperative hyperuricemia, elective cardiac patients with postoperative hyperuricemia have prolonged postoperative treatment in intensive care units, extended durations of mechanically assisted ventilation, and a higher incidence of postoperative circulatory instability, renal failure, and death.<\/jats:p>","DOI":"10.3390\/metabo13050590","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T04:27:02Z","timestamp":1682396822000},"page":"590","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Postoperative Hyperuricemia\u2014A Risk Factor in Elective Cardiosurgical Patients"],"prefix":"10.3390","volume":"13","author":[{"given":"Dominik","family":"Raos","sequence":"first","affiliation":[{"name":"Institute of Emergency Medicine of Zagreb County, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid","family":"Prka\u010din","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0110i\u0111i","family":"Delali\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4808-2968","authenticated-orcid":false,"given":"Tomislav","family":"Bulum","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology, and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8446-6120","authenticated-orcid":false,"given":"Martina","family":"Lovri\u0107 Ben\u010di\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department for Ischemic Heart Disease, University Clinic of Cardiovascular Diseases, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3189-1518","authenticated-orcid":false,"given":"Juraj","family":"Jug","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Health Center Zagreb-West, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jjcc.2020.12.013","article-title":"Uric acid and cardiovascular disease: A clinical review","volume":"78","author":"Saito","year":"2021","journal-title":"J. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1152\/ajpendo.00378.2020","article-title":"New insights into purine metabolism in metabolic diseases: Role of xanthine oxidoreductase activity","volume":"319","author":"Furuhashi","year":"2020","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Aihemaitijiang, S., Zhang, Y., Zhang, L., Yang, J., Ye, C., Halimulati, M., Zhang, W., and Zhang, Z. (2020). The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents. Nutrients, 12.","DOI":"10.3390\/nu12123835"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ijcard.2015.08.109","article-title":"Regulation of uric acid metabolism and excretion","volume":"213","author":"Maiuolo","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000484271","article-title":"Renal Handling of Uric Acid","volume":"192","year":"2018","journal-title":"Contrib. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.semarthrit.2020.04.007","article-title":"The biology of urate","volume":"50","author":"Keenan","year":"2020","journal-title":"Semin. Arthritis. Rheum."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rivera-Paredez, B., Mac\u00edas-Kauffer, L., Fernandez-Lopez, J.C., Villalobos-Compar\u00e1n, M., Martinez-Aguilar, M.M., de la Cruz-Montoya, A., Ram\u00edrez-Salazar, E.G., Villamil-Ram\u00edrez, H., Quiterio, M., and Ram\u00edrez-Palacios, P. (2019). Influence of Genetic and Non-Genetic Risk Factors for Serum Uric Acid Levels and Hyperuricemia in Mexicans. Nutrients, 11.","DOI":"10.3390\/nu11061336"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.jbspin.2018.10.004","article-title":"How should we manage asymptomatic hyperuricemia?","volume":"86","year":"2019","journal-title":"Joint Bone Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4314","DOI":"10.1038\/s41598-018-22570-9","article-title":"Prevalence and correlates of hyperuricemia in the middle-aged and older adults in China","volume":"8","author":"Song","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_10","first-page":"1055","article-title":"Uric acid, Glucose and Lipids in General Population","volume":"4","author":"Nikolac","year":"2011","journal-title":"Coll. Antropol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/0002-9343(87)90441-4","article-title":"Asymptomatic hyperuricaemia. Risk and consequences in the Normative Aging Study","volume":"82","author":"Campion","year":"1987","journal-title":"Am. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1056\/NEJM198501173120305","article-title":"Oxygen-Derived Free Radicals in Postischemic Tissue Injury","volume":"312","author":"McCord","year":"1985","journal-title":"N. Engl. J. Med."},{"key":"ref_13","first-page":"416","article-title":"The URRAH study","volume":"63","author":"Viazzi","year":"2021","journal-title":"Panminerva Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1089\/met.2016.0032","article-title":"Association Between Hyperuricemia and Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction","volume":"15","author":"Ranjith","year":"2017","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e025453","DOI":"10.1136\/bmjopen-2018-025453","article-title":"Relationship between serum uric acid and clustering of cardiovascular disease risk factors and renal disorders among Shanghai population: A multicentre and cross-sectional study","volume":"9","author":"Tao","year":"2019","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1161\/HYPERTENSIONAHA.119.13643","article-title":"Identification of the Uric Acid Thresholds Predicting an Increased Total and Cardiovascular Mortality over 20 Years","volume":"75","author":"Virdis","year":"2020","journal-title":"Hypertension"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"582680","DOI":"10.3389\/fphar.2020.582680","article-title":"Uric Acid and Cardiovascular Disease: An Update From Molecular Mechanism to Clinical Perspective","volume":"11","author":"Yu","year":"2020","journal-title":"Front. Pharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gherghina, M.E., Peride, I., Tiglis, M., Neagu, T.P., Niculae, A., and Checherita, I.A. (2022). Uric Acid and Oxidative Stress-Relationship with Cardiovascular, Metabolic, and Renal Impairment. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23063188"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2128985","DOI":"10.1001\/jamanetworkopen.2021.28985","article-title":"Associations of Serum Uric Acid Levels with Macrovascular and Renal Microvascular Dysfunction Among Individuals From Sub-Saharan Africa","volume":"4","author":"Amoah","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3016","DOI":"10.1016\/j.numecd.2021.07.031","article-title":"Association between uric acid and the prognosis of acute ischemic stroke: A systematic review and meta-analysis","volume":"31","author":"Zhang","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.ejim.2022.04.022","article-title":"Uric acid in metabolic syndrome: Does uric acid have a definitive role?","volume":"103","author":"Copur","year":"2022","journal-title":"Eur. J. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1007\/s11739-022-02982-2","article-title":"Predictive risk factors for death in elderly patients after hospitalization for acute heart failure in an internal medicine unit","volume":"17","author":"Roubille","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e14525","DOI":"10.1097\/MD.0000000000014525","article-title":"Prognostic value of serum uric acid in patients with acute heart failure: A meta-analysis","volume":"98","author":"Huang","year":"2019","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.1161\/CIRCULATIONAHA.118.034365","article-title":"Proteomic Architecture of Human Coronary and Aortic Atherosclerosis","volume":"137","author":"Herrington","year":"2018","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2997","DOI":"10.1093\/eurheartj\/ehaa227","article-title":"Vulnerable plaques and patients: State-of-the-art","volume":"41","author":"Tomaniak","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ijcard.2020.04.074","article-title":"Myocardial ischemia: From disease to syndrome","volume":"314","author":"Marzilli","year":"2020","journal-title":"Int. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"482","DOI":"10.3389\/fphar.2019.00482","article-title":"Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients","volume":"10","author":"Wu","year":"2019","journal-title":"Front. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s40001-021-00501-1","article-title":"EuroScore and IL-6 predict the course in ICU after cardiac surgery","volume":"26","author":"Bauer","year":"2021","journal-title":"Eur. J. Med. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1097\/SLA.0000000000004060","article-title":"Age, Not Sex, Modifies the Effect of Frailty on Long-term Outcomes After Cardiac Surgery","volume":"275","author":"Sun","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/EJA.0000000000000630","article-title":"Management of severe perioperative bleeding: Guidelines from the European Society of Anaesthesiology: First update 2016","volume":"34","author":"Ahmed","year":"2017","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"7","DOI":"10.7326\/0003-4819-131-1-199907060-00003","article-title":"Serum uric acid and risk for cardiovascular disease and death: The Framingham Heart Study","volume":"131","author":"Culleton","year":"1999","journal-title":"Ann. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.1001\/jama.283.18.2404","article-title":"Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971\u20131992. National Health and Nutrition Examination Survey","volume":"283","author":"Fang","year":"2000","journal-title":"JAMA"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/2047487317744045","article-title":"Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery","volume":"25","author":"Lazzeroni","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1111\/jocs.14845","article-title":"Elevated postoperative serum uric acid is associated with major adverse events following coronary artery bypass grafting","volume":"35","author":"Shi","year":"2020","journal-title":"J. Card. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ma, S., Xu, Q., Hu, Q., Huang, L., Wu, D., Lin, G., Chen, X., and Luo, W. (2022). Post-operative uric acid: A predictor for 30-days mortality of acute type A aortic dissection repair. BMC Cardiovasc. Disord., 22.","DOI":"10.1186\/s12872-022-02749-9"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"12289","DOI":"10.1038\/s41598-022-16704-3","article-title":"A retrospective observational study of serum uric acid and in-hospital mortality in acute type A aortic dissection","volume":"12","author":"Yang","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.healun.2018.04.017","article-title":"Uric acid is an independent predictor of cardiac allograft vasculopathy after heart transplantation","volume":"37","author":"Asleh","year":"2018","journal-title":"J. Heart Lung Transplant."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Kaufeld, T., Foerster, K.A., Schilling, T., Kielstein, J.T., Kaufeld, J., Shrestha, M., Haller, H.G., Haverich, A., and Schmidt, B.M.W. (2018). Preoperative serum uric acid predicts incident acute kidney injury following cardiac surgery. BMC Nephrol., 19.","DOI":"10.1186\/s12882-018-0970-x"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e047090","DOI":"10.1136\/bmjopen-2020-047090","article-title":"Effects of hyperuricaemia, with the superposition of being overweight and hyperlipidaemia, on the incidence of acute kidney injury following cardiac surgery: A retrospective cohort study","volume":"12","author":"Su","year":"2022","journal-title":"BMJ Open"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1080\/0886022X.2021.1960563","article-title":"Derivation and validation of a model to predict acute kidney injury following cardiac surgery in patients with normal renal function","volume":"43","author":"Hu","year":"2021","journal-title":"Ren. Fail."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/jocs.15249","article-title":"Development and validation of a model for predicting acute kidney injury after cardiac surgery in patients of advanced age","volume":"36","author":"Hu","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.ijcard.2022.10.147","article-title":"Development and internal validation of a prediction model for acute kidney injury following cardiac valve replacement surgery","volume":"370","author":"Pan","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1048431","DOI":"10.3389\/fsurg.2023.1048431","article-title":"Machine learning in the prediction of cardiac surgery associated acute kidney injury with early postoperative biomarkers","volume":"10","author":"Fan","year":"2023","journal-title":"Front. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1177\/1358863X17721639","article-title":"Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review","volume":"22","author":"Aitken","year":"2017","journal-title":"Vasc. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","article-title":"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit","volume":"291","author":"Ely","year":"2004","journal-title":"JAMA"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Xu, L., Lyu, W., Wei, P., Zheng, Q., Li, C., Zhang, Z., and Li, J. (2022). Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: A matched retrospective case-control study. BMC Anesthesiol., 22.","DOI":"10.1186\/s12871-022-01824-0"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"81","DOI":"10.2147\/CIA.S395893","article-title":"High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery","volume":"18","author":"Liu","year":"2023","journal-title":"Clin. Interv. Aging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"909738","DOI":"10.3389\/fnagi.2022.909738","article-title":"Potential Value of Serum Uric Acid in the Identification of Postoperative Delirium in Geriatric Patients Undergoing Knee Replacement","volume":"14","author":"Wang","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.genhosppsych.2012.06.009","article-title":"Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: A study from India","volume":"34","author":"Sharma","year":"2012","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1016\/j.jtcvs.2020.06.125","article-title":"Risk factors, resource use, and cost of postoperative low cardiac output syndrome","volume":"163","author":"Duncan","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jtcvs.2009.11.022","article-title":"Predictors of low cardiac output syndrome after isolated mitral valve surgery","volume":"140","author":"Maganti","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1093\/ehjacc\/zuac114","article-title":"Predictors and associated clinical outcomes of low cardiac output syndrome following cardiac surgery: Insights from the LEVO-CTS trial","volume":"11","author":"Kochar","year":"2022","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Yu, Z., Kastenm\u00fcller, G., He, Y., Belcredi, P., M\u00f6ller, G., Prehn, C., Mendes, J., Wahl, S., Roemisch-Margl, W., and Ceglarek, U. (2011). Differences between Human Plasma and Serum Metabolite Profiles. 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