The Relationship between Uric Acid/Albumin Ratio and Carotid Intima-Media Thickness in Patients with Hypertension

Şaylık, Faysal; Çınar, Tufan; Selçuk, Murat; Tanboğa, İbrahim Halil

doi:10.36660/abc.20220819

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Original Article • Arq. Bras. Cardiol. 120 (5) • Mar 2023 • https://doi.org/10.36660/abc.20220819 linkcopy

The Relationship between Uric Acid/Albumin Ratio and Carotid Intima-Media Thickness in Patients with Hypertension

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Hypertension causes subendothelial inflammation and dysfunction in resulting atherosclerosis. Carotid intima-media thickness (CIMT) is a useful marker of endothelial dysfunction and atherosclerosis. The uric acid to albumin ratio (UAR) has emerged as a novel marker for predicting cardiovascular events.

Objective We aimed to investigate the association of UAR with CIMT in hypertensive patients.

Methods Two hundred sixteen consecutive hypertensive patients were enrolled in this prospective study. All patients underwent carotid ultrasonography to classify low (CIMT < 0.9 mm) and high (CIMT ≥ 0.9 mm) CIMT groups. The predictive ability of UAR for high CIMT was compared with systemic immune inflammation index (SII), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR). A two-sided p-value <0.05 was accepted as statistically significant.

Results Patients with high CIMT were older and had higher UAR, SII, NLR, and CAR than low CIMT. Age, UAR, SII, NLR, and CAR, but not PLR, were associated with high CIMT. In multivariable analysis, age, CRP, SII, and UAR were independent predictors of high CIMT. The discrimination ability of UAR was higher than uric acid, albumin, SII, NLR, and CAR, and UAR had a higher model fit than those variables. UAR had higher additive improvement in detecting high CIMT than other variables, as assessed with net-reclassification improvement, IDI, and C-statistics. UAR was also significantly correlated with CIMT.

Conclusion UAR might be used to predict high CIMT and might be useful for risk stratification in hypertensive patients.

Carotid Intima-Media Thickness; Uric Acid; Albumins; Hypertension; Biomarkers

Variables	Low CIMT	High CIMT	p-value
Variables	(N=141)	(N=75)	p-value
Age, years	59.0 (7.80)	62.6 (7.23)	0.001
Male gender, n (%)	92 (65.2)	57 (76.0)	0.141
BMI, kg/m²	28.3 (3.04)	28.5 (2.82)	0.605
Diabetes mellitus, n (%)	50 (35.5)	33 (44.0)	0.280
Smoking, n (%)	44 (31.2)	30 (40.0)	0.252
Hyperlipidemia, n (%)	44 (31.2)	27 (36.0)	0.574
WBC, x10³/µL	9.01 (2.77)	9.39 (2.78)	0.334
Hemoglobin, g/dL	13.9 (2.70)	13.2 (2.21)	0.044
Platelets, x10³/µL	279 (37.6)	289 (42.0)	0.093
Neutrophil, x10³/µL	4.80 (0.70)	5.30 (0.75)	<0.001
Lymphocyte, x10³/µL	2.32 (0.70)	2.07 (0.64)	0.009
Creatinine, mg/dL	0.90 (0.04)	0.92 (0.06)	0.025
eGFR, kg/m²	98.7(8.8)	98.1 (6.7)	0.603
Total cholesterol, mg/dL	201 (30.9)	205 (29.1)	0.296
LDL-cholesterol, mg/dL	134 (37.3)	140 (26.1)	0.204
HDL-cholesterol, mg/dL	40.5 (7.51)	38.7 (7.73)	0.107
Triglyceride, mg/dL	168 (11.3)	167 (14.7)	0.630
Uric acid, mg/dL	4.37 (3.83-4.99)	4.93 (4.56-5.48)	<0.001
Albumin, g/dL	3.82 (0.26)	3.70 (0.23)	0.001
Albumin/creatinine ratio	4.23(0.35)	4.04(0.37)	<0.001
C-reactive protein, mg/dL	3.22 (1.14)	3.75 (0.93)	<0.001
UAR	1.16 (0.25)	1.35 (0.19)	<0.001
CAR	0.87 (0.33)	1.11 (0.29)	<0.001
NLR	2.08 (1.65-2.73)	2.47 (1.96-3.32)	<0.001
PLR	119 (99.3-151)	143 (113-177)	0.002
SII	573 (447-733)	835 (626-1055)	<0.001

	UAR < median	UAR ≥ median	p-value
	(N=108)	(N=108)	p-value
Age, years	59.3 (7.60)	61.1 (7.92)	0.093
Male gender, n (%)	72 (66.7)	77 (71.3)	0.556
BMI, kg/m²	28.3 (2.87)	28.4 (3.06)	0.853
Diabetes mellitus, n (%)	39 (36.1)	44 (40.7)	0.576
Smoking, n (%)	34 (31.5)	40 (37.0)	0.473
Hyperlipidemia, n (%)	34 (31.5)	37 (34.3)	0.772
WBC, x10³/µl	8.81 (2.88)	9.48 (2.63)	0.076
Hemoglobin, g/dL	13.7 (2.47)	13.6 (2.64)	0.796
Platelets, x10³/µl	278 (38.9)	287 (39.6)	0.112
Neutrophil, x10³/µl	4.81 (0.72)	5.13 (0.76)	0.002
Lymphocyte, x10³/µl	2.30 (0.69)	2.17 (0.69)	0.175
Creatinine, mg/dL	0.91 (0.05)	0.91 (0.05)	0.277
eGFR, kg/m²	98.6 (8.4)	98.4 (7.7)	0.814
Total cholesterol, mg/dL	203 (31.0)	202 (29.7)	0.808
LDL-cholesterol, mg/dL	132 (34.3)	140 (33.1)	0.111
HDL-cholesterol, mg/dL	40.1 (7.72)	39.6 (7.54)	0.638
Triglyceride, mg/dL	168 (11.9)	167 (13.2)	0.551
Uric acid, mg/dL	4.03 (3.65-4.43)	5.30 (4.85-5.64)	<0.001
Albumin, g/dL	3.86 (0.24)	3.69 (0.25)	<0.001
Albumin/creatinine ratio	4.28(0.35)	4.05(0.36)	<0.001
C-reactive protein, mg/dL	3.29 (1.18)	3.52 (0.99)	0.114
UAR	1.03 (0.15)	1.43 (0.14)	<0.001
CAR	0.88 (0.34)	1.03 (0.31)	0.001
NLR	2.14 (1.70-2.61)	2.37 (1.88-3.13)	0.027
PLR	121 (101-151)	128 (107-178)	0.086
SII	595 (478-767)	720 (562-999)	0.002
CIMT, mm	0.73 (0.65-0.86)	0.89 (0.80-1.00)	<0.001

Variables	Univariable regression			Multivariable regression

	OR	95% CI	p-value	OR	95% CI	p-value
Age	1.066	1.026, 1.109	0,001	1.047	1.004, 1.094	0,034
Creatinine	1.074	1.015, 1.140	0,016	1.053	0,99, 1,124	0,111
C-reactive protein	1.591	1.212, 2.123	0,001	1.537	1.116, 2.155	0,010
Neutrophil	2.670	1.757, 4.192	0,000	-	-	-
Lymphocyte	0,581	0,375, 0,883	0,012	-	-	-
SII	1.002	1.001, 1.003	0,000	1.001	1.000, 1.002	0,019
CAR	11.47	4.346, 33.13	0,000	-	-	-
NLR	1.391	1.088, 1.845	0,016	-	-	-
PLR	1.003	1.000, 1.007	0,121	-	-	-
UAR	1.038	1.024, 1.054	0,000	1.032	1.016, 1.049	0,000

	AIC	BIC	-2LL	Nagelkarke R2	c statistic	Brier-Scaled
PLR	295	305	275.6	0.021	0.626	0.224
NLR	292	302	270.5	0.053	0.657	0.218
CAR	271	282	252.1	0.161	0.706	0.202
SII	259	269	237	0.204	0.750	0.194
UAR	246	257	226	0.297	0.783	0.178

	C-statistic difference	NRI (95 % CI)	IDI (95 % CI)
SII	0.659-0.745 (p=0.002)	0.049 (0.014-0.086) (p=0.007)	0.069 0.036-0.102) (p<0.001)
NLR	0.659-0.698 (p= 0.038)	0.021 (-0.003-0.045) (p=0.079)	0.025 (0.003-0.047) (p=0.028)
PLR	0.659-0.671 (p=0.231)	0.007 (-0.007-0.021) (p= 0.316)	0.009 (-0.006-0.023) (p=0.231)
CAR	0.659-0.753 (p=0.003)	0.101 (0.035-0.167) (p=0.003)	0.101 (0.061-0.141) (p<0.001)
UAR	0.659-0.765 (p=0.001)	0.163 (0.102-0.224) (p<0.001)	0.109 (0.067-0.151) (p<0.001)

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[TFN1001] CIMT: carotid-intima media thickness; BMI: body mass index; WBC: white blood cell; eGFR: estimated glomerular filtration rate; LDL: low-density; HDL: high-density; UAR: uric acid/albumin ratio; CAR: C-reactive protein/albumin ratio; NLR: neutrophil/lymphocyte ratio; PLR: platelet/lymphocyte ratio; SII: systemic immune-inflammation index.