Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome
Identifieur interne : 000D74 ( Pmc/Corpus ); précédent : 000D73; suivant : 000D75Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome
Auteurs : Vin-Cent Wu ; Jenq-Wen Huang ; Po-Ren Hsueh ; Ya-Fei Yang ; Hung-Bin Tsai ; Wei-Chih Kan ; Hong-Wei Chang ; Kwan-Dun WuSource :
- American Journal of Kidney Diseases [ 0272-6386 ] ; 2005.
Abstract
Url:
DOI: 10.1053/j.ajkd.2004.09.031
PubMed: 15696447
PubMed Central: 7115701
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome</title><author><name sortKey="Wu, Vin Cent" sort="Wu, Vin Cent" uniqKey="Wu V" first="Vin-Cent" last="Wu">Vin-Cent Wu</name><affiliation><nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Huang, Jenq Wen" sort="Huang, Jenq Wen" uniqKey="Huang J" first="Jenq-Wen" last="Huang">Jenq-Wen Huang</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Hsueh, Po Ren" sort="Hsueh, Po Ren" uniqKey="Hsueh P" first="Po-Ren" last="Hsueh">Po-Ren Hsueh</name><affiliation><nlm:aff id="aff3">Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Yang, Ya Fei" sort="Yang, Ya Fei" uniqKey="Yang Y" first="Ya-Fei" last="Yang">Ya-Fei Yang</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Tsai, Hung Bin" sort="Tsai, Hung Bin" uniqKey="Tsai H" first="Hung-Bin" last="Tsai">Hung-Bin Tsai</name><affiliation><nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Kan, Wei Chih" sort="Kan, Wei Chih" uniqKey="Kan W" first="Wei-Chih" last="Kan">Wei-Chih Kan</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chang, Hong Wei" sort="Chang, Hong Wei" uniqKey="Chang H" first="Hong-Wei" last="Chang">Hong-Wei Chang</name><affiliation><nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Wu, Kwan Dun" sort="Wu, Kwan Dun" uniqKey="Wu K" first="Kwan-Dun" last="Wu">Kwan-Dun Wu</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">15696447</idno><idno type="pmc">7115701</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115701</idno><idno type="RBID">PMC:7115701</idno><idno type="doi">10.1053/j.ajkd.2004.09.031</idno><date when="2005">2005</date><idno type="wicri:Area/Pmc/Corpus">000D74</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000D74</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome</title><author><name sortKey="Wu, Vin Cent" sort="Wu, Vin Cent" uniqKey="Wu V" first="Vin-Cent" last="Wu">Vin-Cent Wu</name><affiliation><nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Huang, Jenq Wen" sort="Huang, Jenq Wen" uniqKey="Huang J" first="Jenq-Wen" last="Huang">Jenq-Wen Huang</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Hsueh, Po Ren" sort="Hsueh, Po Ren" uniqKey="Hsueh P" first="Po-Ren" last="Hsueh">Po-Ren Hsueh</name><affiliation><nlm:aff id="aff3">Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Yang, Ya Fei" sort="Yang, Ya Fei" uniqKey="Yang Y" first="Ya-Fei" last="Yang">Ya-Fei Yang</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Tsai, Hung Bin" sort="Tsai, Hung Bin" uniqKey="Tsai H" first="Hung-Bin" last="Tsai">Hung-Bin Tsai</name><affiliation><nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Kan, Wei Chih" sort="Kan, Wei Chih" uniqKey="Kan W" first="Wei-Chih" last="Kan">Wei-Chih Kan</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Chang, Hong Wei" sort="Chang, Hong Wei" uniqKey="Chang H" first="Hong-Wei" last="Chang">Hong-Wei Chang</name><affiliation><nlm:aff id="aff1">Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</nlm:aff></affiliation></author><author><name sortKey="Wu, Kwan Dun" sort="Wu, Kwan Dun" uniqKey="Wu K" first="Kwan-Dun" last="Wu">Kwan-Dun Wu</name><affiliation><nlm:aff id="aff2">Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff></affiliation></author></analytic><series><title level="j">American Journal of Kidney Diseases</title><idno type="ISSN">0272-6386</idno><idno type="eISSN">1523-6838</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic><underline>Background:</underline></italic> The purpose of this study is to determine the incidence and significance of hypouricemia in patients with severe acute respiratory syndrome (SARS). Pulmonary lesions in patients with SARS are thought to result from proinflammatory cytokine dysregulation. Acute renal failure has been reported in patients with SARS, but whether cytokines can injure renal tubules is unknown. <italic><underline>Methods:</underline></italic> Sixty patients diagnosed with SARS in Taiwan in April 2003 were studied. Patients were identified as hypouricemic when their serum uric acid (UA) level was less than 2.5 mg/dL (<149 μmol/L) within 15 days after fever onset. Urine UA and creatinine levels were available for 43 patients; the serum cytokines interleukin-6 (IL-6), IL-8, and tumor necrosis factor-α (TNF-α) were measured in 16 patients. <italic><underline>Results:</underline></italic> Sixteen patients (26.7%) had hypouricemia (UA, 1.68 ± 0.52 mg/dL [100 ± 31 μmol/L]). No differences in age, sex, symptoms, vital signs, hemogram, or other biochemistry data existed between the hypouricemic and normouricemic groups. Fractional excretion (FE) of UA (FE<sub>UA</sub>) in 12 hypouricemic patients was 39.6% ± 23.4%, significantly greater than that of 31 normouricemic patients (16.4% ± 11.4%; <italic>P</italic> < 0.0001). After adjustments for age and sex, high FE<sub>UA</sub> was significantly associated with the lowest blood oxygenation (<italic>P</italic> = 0.001; <italic>r</italic> = −0.624). The number of catastrophic outcomes (endotracheal intubation and/or death) adjusted for older age and sex showed that hypouremic patients had an odds ratio of 10.57 (confidence interval, 2.33 to 47.98; <italic>P</italic> = 0.002). Kaplan-Meier curves for catastrophic outcome–free results showed significant differences between patients with normouricemia or hypouricemia (<italic>P</italic> = 0.01). Serum IL-8 levels correlated significantly with FE<sub>UA</sub> (<italic>P</italic> < 0.001; <italic>r</italic> = 0.785) and inversely with serum UA level (<italic>P</italic> = 0.044; <italic>r</italic> = −0.509); neither IL-6 nor TNF-α level showed such correlations. <italic><underline>Conclusion:</underline></italic> One fourth of patients with SARS developed hypouricemia, which might result from a defect in renal UA handling and was associated with a high serum IL-8 level. Renal hypouricemia is an ominous sign in patients with SARS.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ksiazek, T G" uniqKey="Ksiazek T">T.G. Ksiazek</name></author><author><name sortKey="Erdman, D" uniqKey="Erdman D">D. Erdman</name></author><author><name sortKey="Goldsmith, C S" uniqKey="Goldsmith C">C.S. Goldsmith</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peiris, J S" uniqKey="Peiris J">J.S. Peiris</name></author><author><name sortKey="Chu, C M" uniqKey="Chu C">C.M. Chu</name></author><author><name sortKey="Cheng, V C" uniqKey="Cheng V">V.C. Cheng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsai, H B" uniqKey="Tsai H">H.B. Tsai</name></author><author><name sortKey="Huang, J W" uniqKey="Huang J">J.W. Huang</name></author><author><name sortKey="Chen, K Y" uniqKey="Chen K">K.Y. Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wu, V C" uniqKey="Wu V">V.C. Wu</name></author><author><name sortKey="Hsueh, P R" uniqKey="Hsueh P">P.R. Hsueh</name></author><author><name sortKey="Lin, W C" uniqKey="Lin W">W.C. Lin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vas, S I" uniqKey="Vas S">S.I. Vas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Glassock, R J" uniqKey="Glassock R">R.J. Glassock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maesaka, J K" uniqKey="Maesaka J">J.K. Maesaka</name></author><author><name sortKey="Cusano, A J" uniqKey="Cusano A">A.J. Cusano</name></author><author><name sortKey="Thies, H L" uniqKey="Thies H">H.L. Thies</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ogino, K" uniqKey="Ogino K">K. Ogino</name></author><author><name sortKey="Hisatome, I" uniqKey="Hisatome I">I. Hisatome</name></author><author><name sortKey="Saitoh, M" uniqKey="Saitoh M">M. Saitoh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, J T" uniqKey="Wang J">J.T. Wang</name></author><author><name sortKey="Wang, J L" uniqKey="Wang J">J.L. Wang</name></author><author><name sortKey="Fang, C T" uniqKey="Fang C">C.T. Fang</name></author><author><name sortKey="Chang, S C" uniqKey="Chang S">S.C. Chang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wang, J T" uniqKey="Wang J">J.T. Wang</name></author><author><name sortKey="Sheng, W H" uniqKey="Sheng W">W.H. Sheng</name></author><author><name sortKey="Fang, C T" uniqKey="Fang C">C.T. Fang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maesaka, J K" uniqKey="Maesaka J">J.K. Maesaka</name></author><author><name sortKey="Fishbane, S" uniqKey="Fishbane S">S. Fishbane</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bairaktari, E T" uniqKey="Bairaktari E">E.T. Bairaktari</name></author><author><name sortKey="Kakafika, A I" uniqKey="Kakafika A">A.I. Kakafika</name></author><author><name sortKey="Pritsivelis, N" uniqKey="Pritsivelis N">N. Pritsivelis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bairaktari, E" uniqKey="Bairaktari E">E. Bairaktari</name></author><author><name sortKey="Liamis, G" uniqKey="Liamis G">G. Liamis</name></author><author><name sortKey="Tsolas, O" uniqKey="Tsolas O">O. Tsolas</name></author><author><name sortKey="Elisaf, M" uniqKey="Elisaf M">M. Elisaf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Booth, C M" uniqKey="Booth C">C.M. Booth</name></author><author><name sortKey="Matukas, L M" uniqKey="Matukas L">L.M. Matukas</name></author><author><name sortKey="Tomlinson, G A" uniqKey="Tomlinson G">G.A. Tomlinson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moreno Monteagudo, J A" uniqKey="Moreno Monteagudo J">J.A. Moreno-Monteagudo</name></author><author><name sortKey="Fernandez Bermejo, M" uniqKey="Fernandez Bermejo M">M. Fernandez-Bermejo</name></author><author><name sortKey="Garcia Buey, L" uniqKey="Garcia Buey L">L. Garcia-Buey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abou Mourad, N N" uniqKey="Abou Mourad N">N.N. Abou-Mourad</name></author><author><name sortKey="Chamberlain, B E" uniqKey="Chamberlain B">B.E. Chamberlain</name></author><author><name sortKey="Ackerman, N B" uniqKey="Ackerman N">N.B. Ackerman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Collazos, J" uniqKey="Collazos J">J. Collazos</name></author><author><name sortKey="Blanco, M S" uniqKey="Blanco M">M.S. Blanco</name></author><author><name sortKey="Guerra, E" uniqKey="Guerra E">E. Guerra</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chertow, G M" uniqKey="Chertow G">G.M. Chertow</name></author><author><name sortKey="Seifter, J L" uniqKey="Seifter J">J.L. Seifter</name></author><author><name sortKey="Christiansen, C L" uniqKey="Christiansen C">C.L. Christiansen</name></author><author><name sortKey="O Onnell, W J" uniqKey="O Onnell W">W.J. O’Donnell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rafey, M A" uniqKey="Rafey M">M.A. Rafey</name></author><author><name sortKey="Lipkowitz, M S" uniqKey="Lipkowitz M">M.S. Lipkowitz</name></author><author><name sortKey="Leal Pinto, E" uniqKey="Leal Pinto E">E. Leal-Pinto</name></author><author><name sortKey="Abramson, R G" uniqKey="Abramson R">R.G. Abramson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Enomoto, A" uniqKey="Enomoto A">A. Enomoto</name></author><author><name sortKey="Kimura, H" uniqKey="Kimura H">H. Kimura</name></author><author><name sortKey="Chairoungdua, A" uniqKey="Chairoungdua A">A. Chairoungdua</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ichida, K" uniqKey="Ichida K">K. Ichida</name></author><author><name sortKey="Hosoyamada, M" uniqKey="Hosoyamada M">M. Hosoyamada</name></author><author><name sortKey="Hisatome, I" uniqKey="Hisatome I">I. Hisatome</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Urano, W" uniqKey="Urano W">W. Urano</name></author><author><name sortKey="Yamanaka, H" uniqKey="Yamanaka H">H. Yamanaka</name></author><author><name sortKey="Tsutani, H" uniqKey="Tsutani H">H. Tsutani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Puma, C" uniqKey="Puma C">C. Puma</name></author><author><name sortKey="Danik, M" uniqKey="Danik M">M. Danik</name></author><author><name sortKey="Quirion, R" uniqKey="Quirion R">R. Quirion</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Qiu, M R" uniqKey="Qiu M">M.R. Qiu</name></author><author><name sortKey="Campbell, T J" uniqKey="Campbell T">T.J. Campbell</name></author><author><name sortKey="Breit, S N" uniqKey="Breit S">S.N. Breit</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hsueh, P R" uniqKey="Hsueh P">P.R. Hsueh</name></author><author><name sortKey="Chen, P J" uniqKey="Chen P">P.J. Chen</name></author><author><name sortKey="Hsiao, C H" uniqKey="Hsiao C">C.H. Hsiao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, J Y" uniqKey="Wang J">J.Y. Wang</name></author><author><name sortKey="Chen, K Y" uniqKey="Chen K">K.Y. Chen</name></author><author><name sortKey="Wang, J T" uniqKey="Wang J">J.T. Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sahebjami, H" uniqKey="Sahebjami H">H. Sahebjami</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hink, H U" uniqKey="Hink H">H.U. Hink</name></author><author><name sortKey="Santanam, N" uniqKey="Santanam N">N. Santanam</name></author><author><name sortKey="Dikalov, S" uniqKey="Dikalov S">S. Dikalov</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ames, B N" uniqKey="Ames B">B.N. Ames</name></author><author><name sortKey="Cathcart, R" uniqKey="Cathcart R">R. Cathcart</name></author><author><name sortKey="Schwiers, E" uniqKey="Schwiers E">E. Schwiers</name></author><author><name sortKey="Hochstein, P" uniqKey="Hochstein P">P. Hochstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maxwell, S R" uniqKey="Maxwell S">S.R. Maxwell</name></author><author><name sortKey="Thomason, H" uniqKey="Thomason H">H. Thomason</name></author><author><name sortKey="Sandler, D" uniqKey="Sandler D">D. Sandler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bower, R H" uniqKey="Bower R">R.H. Bower</name></author><author><name sortKey="Cerra, F B" uniqKey="Cerra F">F.B. Cerra</name></author><author><name sortKey="Bershadsky, B" uniqKey="Bershadsky B">B. Bershadsky</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hsu, S P" uniqKey="Hsu S">S.P. Hsu</name></author><author><name sortKey="Pai, M F" uniqKey="Pai M">M.F. Pai</name></author><author><name sortKey="Peng, Y S" uniqKey="Peng Y">Y.S. Peng</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Kidney Dis</journal-id><journal-id journal-id-type="iso-abbrev">Am. J. Kidney Dis</journal-id><journal-title-group><journal-title>American Journal of Kidney Diseases</journal-title></journal-title-group><issn pub-type="ppub">0272-6386</issn><issn pub-type="epub">1523-6838</issn><publisher><publisher-name>National Kidney Foundation, Inc. Published by Elsevier Inc.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">15696447</article-id><article-id pub-id-type="pmc">7115701</article-id><article-id pub-id-type="publisher-id">S0272-6386(04)01418-0</article-id><article-id pub-id-type="doi">10.1053/j.ajkd.2004.09.031</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Vin-Cent</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Huang</surname><given-names>Jenq-Wen</given-names></name><degrees>MD</degrees><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Hsueh</surname><given-names>Po-Ren</given-names></name><degrees>MD</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Yang</surname><given-names>Ya-Fei</given-names></name><degrees>MD</degrees><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Tsai</surname><given-names>Hung-Bin</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Kan</surname><given-names>Wei-Chih</given-names></name><degrees>MD</degrees><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Chang</surname><given-names>Hong-Wei</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Kwan-Dun</given-names></name><degrees>MD, PhD</degrees><email>kdw@ntumc.org</email><xref rid="aff2" ref-type="aff">b</xref><xref rid="cor1" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><collab>SARS Research Group of National Taiwan University College of Medicine and National Taiwan University Hospital</collab></contrib></contrib-group><aff id="aff1"><label>a</label>Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan</aff><aff id="aff2"><label>b</label>Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan</aff><aff id="aff3"><label>c</label>Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan</aff><author-notes><corresp id="cor1"><label>*</label>Address reprint requests to Kwan-Dun Wu, MD, PhD, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, Taiwan <email>kdw@ntumc.org</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>21</day><month>2</month><year>2008</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>1</month><year>2005</year></pub-date><pub-date pub-type="epub"><day>21</day><month>2</month><year>2008</year></pub-date><volume>45</volume><issue>1</issue><fpage>88</fpage><lpage>95</lpage><history><date date-type="received"><day>16</day><month>6</month><year>2004</year></date><date date-type="accepted"><day>9</day><month>9</month><year>2004</year></date></history><permissions><copyright-statement>Copyright © 2004 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</copyright-statement><copyright-year>2004</copyright-year><copyright-holder>National Kidney Foundation, Inc.</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract><p><italic><underline>Background:</underline></italic> The purpose of this study is to determine the incidence and significance of hypouricemia in patients with severe acute respiratory syndrome (SARS). Pulmonary lesions in patients with SARS are thought to result from proinflammatory cytokine dysregulation. Acute renal failure has been reported in patients with SARS, but whether cytokines can injure renal tubules is unknown. <italic><underline>Methods:</underline></italic> Sixty patients diagnosed with SARS in Taiwan in April 2003 were studied. Patients were identified as hypouricemic when their serum uric acid (UA) level was less than 2.5 mg/dL (<149 μmol/L) within 15 days after fever onset. Urine UA and creatinine levels were available for 43 patients; the serum cytokines interleukin-6 (IL-6), IL-8, and tumor necrosis factor-α (TNF-α) were measured in 16 patients. <italic><underline>Results:</underline></italic> Sixteen patients (26.7%) had hypouricemia (UA, 1.68 ± 0.52 mg/dL [100 ± 31 μmol/L]). No differences in age, sex, symptoms, vital signs, hemogram, or other biochemistry data existed between the hypouricemic and normouricemic groups. Fractional excretion (FE) of UA (FE<sub>UA</sub>) in 12 hypouricemic patients was 39.6% ± 23.4%, significantly greater than that of 31 normouricemic patients (16.4% ± 11.4%; <italic>P</italic> < 0.0001). After adjustments for age and sex, high FE<sub>UA</sub> was significantly associated with the lowest blood oxygenation (<italic>P</italic> = 0.001; <italic>r</italic> = −0.624). The number of catastrophic outcomes (endotracheal intubation and/or death) adjusted for older age and sex showed that hypouremic patients had an odds ratio of 10.57 (confidence interval, 2.33 to 47.98; <italic>P</italic> = 0.002). Kaplan-Meier curves for catastrophic outcome–free results showed significant differences between patients with normouricemia or hypouricemia (<italic>P</italic> = 0.01). Serum IL-8 levels correlated significantly with FE<sub>UA</sub> (<italic>P</italic> < 0.001; <italic>r</italic> = 0.785) and inversely with serum UA level (<italic>P</italic> = 0.044; <italic>r</italic> = −0.509); neither IL-6 nor TNF-α level showed such correlations. <italic><underline>Conclusion:</underline></italic> One fourth of patients with SARS developed hypouricemia, which might result from a defect in renal UA handling and was associated with a high serum IL-8 level. Renal hypouricemia is an ominous sign in patients with SARS.</p></abstract><kwd-group><title>Index words</title><kwd>Hypouricemia</kwd><kwd>severe acute respiratory syndrome (SARS)</kwd><kwd>uric acid (UA)</kwd><kwd>fraction excretion (FE)</kwd><kwd>renal tubule</kwd></kwd-group></article-meta></front><body><p>PATIENTS WITH severe acute respiratory syndrome (SARS) caused by a new coronavirus (CoV) present with fever and respiratory symptoms.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> Although the virus can be found in urine from patients,<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref> renal function usually is preserved and acute renal failure (ARF) is uncommon.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> Causes of ARF in the patients with SARS we studied were multifactorial, eg, infections, rhabdomyolysis, antiviral agents, and hypoxemia. However, we observed that the elevation in serum creatinine levels in patients with ARF was preceded by increased serum cytokine levels, indicating that proinflammatory cytokine-related renal lesions may have an important role.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref></p><p>Direct and indirect associations of viral infections with human renal diseases have been noted for years,<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> and several pathogenic mechanisms have been postulated as contributing to the renal diseases associated with viral infections.<xref rid="bib6" ref-type="bibr"><sup>6</sup></xref> Most virus-related renal diseases mainly involve glomeruli. However, lesions of the renal tubules and interstitium have been reported infrequently.<xref rid="bib7" ref-type="bibr"><sup>7</sup></xref> We showed interstitial infiltrations of inflammatory cells in renal histological specimens obtained at necropsy for 2 patients with SARS complicated by ARF.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> Taking these observations together, we speculate that significant elevations in proinflammatory cytokine levels may have a pivotal role in renal injury in patients with SARS.</p><p>Proximal tubular injury is observed commonly in patients with interstitial inflammation and clinically manifested by defects in organic acid and electrolyte transport. Hypouricemia caused by uricosuria has been shown in patients with acute and chronic tubulointerstitial nephritis, but rarely has been reported in patients with systemic infections without frank renal disease.<xref rid="bib7" ref-type="bibr">7</xref>, <xref rid="bib8" ref-type="bibr">8</xref> Although the mechanism is not elucidated, renal hypouricemia in patients with systemic infections has been shown to be a factor in poor prognosis.<xref rid="bib7" ref-type="bibr"><sup>7</sup></xref> In the present study, we examine the prevalence of hypouricemia in patients with SARS and its significance to the outcomes of these patients.</p><sec><title>Methods</title><sec><title>Patients</title><p>Seventy-four patients with probable SARS were admitted to this hospital from April 19 to May 16, 2003, when endemic SARS occurred on this island.<xref rid="bib9" ref-type="bibr"><sup>9</sup></xref> The diagnosis of probable SARS was made in the presence of fever greater than 38°C, respiratory symptoms, contact history, and either pneumonic patch on chest film or positive test for CoV, a definition for probable SARS by the Centers for Disease Control and Prevention and World Health Organization.<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib10" ref-type="bibr">10</xref>, <xref rid="bib11" ref-type="bibr">11</xref> Seven patients were excluded from this study because diuretics were administered during blood sampling; another 7 patients were excluded because they had only 1 test of serum uric acid (UA) within 15 days after the onset of fever.</p><p>SARS-CoV had been detected in 18 patients (30%) by means of reverse-transcriptase polymerase chain reaction of throat swabs. Another 36 patients who had negative throat swab results for SARS-CoV had seroconversion detected by means of immunofluorescent assay in 26 patients (43.3%) and by means of enzyme-linked immunosorbent assay in 10 patients (16.7%). The other 6 patients (10%), who had no direct microbiological or serological evidence of SARS-CoV infection by the end of the study, had clinical courses compatible with those of probable SARS. They had a clear relationship, as well as exposure, to initial immigrant clusters and later intrahospital outbreaks in Taiwan.<xref rid="bib12" ref-type="bibr"><sup>12</sup></xref> The diagnosis of SARS in these patients had been confirmed by a committee of the Center for Disease Control (Taiwan).</p></sec><sec><title>Definition of hypouricemia and inappropriate uricosuria</title><p>Serum UA was measured at least twice in all patients included in this study. However, because blood sampling was not performed on a fixed schedule, data were clustered in 3 periods after the onset of fever. If more than 2 measurements were obtained in any period, the lowest level in that period was used for analysis. When multiple daily measurements were performed, data obtained closest to 8:00 <sc>am</sc> was analyzed. Hypouricemia is defined when a serum UA level within 15 days after onset of fever was less than 2.5 mg/dL (<149 μmol/L), which is more than 2 SDs less than the mean UA level measured in this hospital. A standard formula was used to calculate fractional excretion (FE) of UA (FE<sub>UA</sub>);
<disp-formula><mml:math id="M1" altimg="si1.gif" overflow="scroll"><mml:mrow><mml:msub><mml:mrow><mml:mtext>FE</mml:mtext></mml:mrow><mml:mrow><mml:mtext>UA</mml:mtext></mml:mrow></mml:msub><mml:mo>=</mml:mo><mml:mtext>urine UA</mml:mtext><mml:mo>×</mml:mo><mml:mtext>serum creatinine</mml:mtext><mml:mo>/</mml:mo><mml:mtext>urine creatinine</mml:mtext><mml:mo>×</mml:mo><mml:mtext>serum UA</mml:mtext></mml:mrow></mml:math></disp-formula></p><p>In hypouricemic patients, FE<sub>UA</sub> greater than 10% is defined as inappropriate uricosuria.<xref rid="bib13" ref-type="bibr">13</xref>, <xref rid="bib14" ref-type="bibr">14</xref></p></sec><sec><title>Laboratory measurements</title><p>Biochemical parameters were measured using the Toshiba TBA-200FR Clinical Chemistry analyzer (Toshiba, Tochigi-ken, Japan); UA was measured using the uricase method.<xref rid="bib15" ref-type="bibr"><sup>15</sup></xref> Serum levels of tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), and IL-8 were determined by using an immunometric assay (Immulite; Diagnostic Products Corp, Los Angeles, CA).</p><p>Blood oxygen saturation of hospitalized patients was automatically recorded 3 times every day by using pulse oximetry (Agilent, Andover, MA). The lowest value on the day renal excretion of UA was studied was used for analysis.</p></sec><sec><title>Statistical analysis</title><p>Results are expressed as mean ± SD unless otherwise specified. Unpaired Student’s <italic>t</italic>-test was applied to analyze continuous data, and either chi-square test or Fisher’s exact test was applied to analyze categorical data. Statistical analyses were performed using SPSS for Windows, version 10.0 (SPSS Inc, Chicago, IL). Comparison of data between groups was made using a <italic>t</italic>-test for random data. In addition, repeated measurements of UA variables with hypouremic and normouremic patients were analyzed by using analysis of variance. If results differed significantly, a post hoc comparison was performed using a <italic>t</italic>-test for paired data and Scheffé test.</p><p>A catastrophic outcome is defined as death or need for mechanical ventilation.<xref rid="bib16" ref-type="bibr"><sup>16</sup></xref> Time to discharge and time to catastrophic outcome were examined by using survival analysis, with follow-up for all patients starting at fever onset and ending after discharge. Data were censored if, at the end of follow-up, patients were still in the hospital (for time to discharge), were still alive (from time to death), and did not have a catastrophic outcome. The Kaplan-Meier (product-limit) method was used to estimate survival and plot time to event between the hypouricemia and normouricemia groups, and log-rank test, to compare differences between groups.<xref rid="bib13" ref-type="bibr"><sup>13</sup></xref></p><p><italic>P</italic> less than 0.05 is considered statistically significant.</p></sec></sec><sec><title>Results</title><sec><title>Patient characteristics</title><p>Patient age was 47 ± 17 years, and there were 30 women and 30 men. Thirty-five, 54, and 55 patients had serum UA levels measured at 1 to 5, 6 to 9, and 10 to 15 days after fever onset, respectively. Sixteen patients (26.7%) were hypouricemic, with a serum UA level of 1.68 ± 0.59 mg/dL (100 ± 35 μmol/L); the remainder had a serum UA level of 4.56 ± 1.41 mg/dL (271 ± 84 μmol/L). As shown in <xref rid="fig1" ref-type="fig">Fig 1</xref>, at each period, hypouricemic patients had lower serum UA levels than normouricemic patients. In hypouricemic patients, the lowest serum UA level was observed 6 to 9 days after the onset of fever (<italic>P</italic> = 0.001 compared with days 1 to 5) and returned to baseline 10 to 15 days after fever onset (<italic>P</italic> = 0.565 compared with days 1 to 5). Conversely, serum UA levels in normouricemic patients were unchanged during this time (<italic>P</italic> = 0.770). Eleven hypouricemic patients had serum UA levels return to normal (UA > 2.5 mg/dL) after fever onset (day 12.3 ± 1.9).<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref> Four patients remained hypouricemic after day 16, and 1 patient was without UA data after day 12. Patients with persistent hypouricemia showed a graver prognosis than patients with corrected hypouricemia (intubated or dead, <italic>P</italic> = 0.016).<fig id="fig1"><label>Fig 1</label><caption><p>Serum UA levels in patients with SARS measured in different periods after fever: 1 to 5, 6 to 9, and 10 to 14 days. Sixteen patients were identified as hypouricemic (dotted bar), and 44 patients, normouricemic (black bar). Numbers in parentheses indicate the number of patients with serum UA measurements in that period. *<italic>P</italic> = 0.001.</p></caption><graphic xlink:href="gr1"></graphic></fig></p><p>There were no differences in age, sex, symptoms (ie, sore throat, runny nose, cough, myalgia, and diarrhea), or vital signs on admission between the 2 groups (<xref rid="tbl1" ref-type="table">Table 1</xref>). Prevalences of hypertension, diabetes, and ischemic heart disease were the same between the 2 groups (<xref rid="tbl1" ref-type="table">Table 1</xref>).<table-wrap position="float" id="tbl1"><label>Table 1</label><caption><p>Characteristics of Patients</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center"></th><th align="center">Hypouricemic Group (n = 16)</th><th align="center">Normouricemic Group (n = 44)</th><th align="center"><italic>P</italic></th></tr></thead><tbody><tr><td>Sex (M/F)</td><td>7/9</td><td>23/21</td><td>0.386</td></tr><tr><td>Age (y)</td><td>50.2 ± 16.7</td><td>46.3 ± 17.5</td><td>0.448</td></tr><tr><td>Vital signs at admission</td><td></td><td></td><td></td></tr><tr><td> Systolic blood pressure (mm Hg)</td><td align="char">136.7 ± 23.4</td><td align="char">133.9 ± 25.9</td><td>0.732</td></tr><tr><td> Diastolic blood pressure (mm Hg)</td><td align="char">84.2 ± 16.7</td><td align="char">77.02 ± 12.2</td><td>0.098</td></tr><tr><td> Heart rate (beats/min)</td><td align="char">94.1 ± 15.1</td><td align="char">97.7 ± 15.5</td><td>0.477</td></tr><tr><td> Temperature (°C)</td><td align="char">38.4 ± 1.0</td><td align="char">37.9 ± 0.97</td><td>0.152</td></tr><tr><td>Symptoms</td><td></td><td></td><td></td></tr><tr><td> Sore throat</td><td align="char">1 (7.69)</td><td align="char">7 (15.91)</td><td>0.287</td></tr><tr><td> Cough</td><td align="char">7 (43.75)</td><td align="char">18 (40.91)</td><td>0.459</td></tr><tr><td> Myalgia</td><td align="char">8 (50.00)</td><td align="char">23 (52.27)</td><td>0.487</td></tr><tr><td> Diarrhea</td><td align="char">8 (50.00)</td><td align="char">14 (31.81)</td><td>0.193</td></tr><tr><td>Comorbidities</td><td></td><td></td><td></td></tr><tr><td> Hypertension</td><td align="char">1 (6.25)</td><td align="char">5 (11.36)</td><td>0.655</td></tr><tr><td> Ischemic heart disease</td><td align="char">0 (0)</td><td align="char">2 (4.55)</td><td>0.547</td></tr><tr><td> Diabetes</td><td align="char">2 (12.50)</td><td align="char">7 (15.91)</td><td>0.551</td></tr></tbody></table><table-wrap-foot><fn><p>NOTE. Results expressed as number (%) or mean ± SD.</p></fn></table-wrap-foot></table-wrap></p><p>Hemograms and biochemical parameter measurements at admission are listed in <xref rid="tbl2" ref-type="table">Table 2</xref>. There were no differences between the 2 groups in white blood cell count, hematocrit value, platelet count, or levels of urea nitrogen, serum creatinine, creatine kinase, and electrolytes.<table-wrap position="float" id="tbl2"><label>Table 2</label><caption><p>Hemogram and Biochemical Parameters in Normouricemic and Hypouricemic Patients With SARS</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center"></th><th align="center">Hypouricemic (n = 16)</th><th align="center">Normouricemic (n = 44)</th><th align="center"><italic>P</italic></th></tr></thead><tbody><tr><td>Lowest count of</td><td></td><td></td><td></td></tr><tr><td> White blood cells (/μL)</td><td>3,909 ± 2,265</td><td>4,468 ± 3,191</td><td>0.963</td></tr><tr><td> Absolute neutrophils (/μL)</td><td>367 ± 191</td><td>450 ± 243</td><td>0.237</td></tr><tr><td>Peak levels of</td><td></td><td></td><td></td></tr><tr><td> White blood cells (/μL)</td><td>12,681 ± 6,190</td><td>12,582 ± 7,603</td><td>0.524</td></tr><tr><td> Blood urea nitrogen (mg/dL)</td><td>33.8 ± 23.6</td><td>33.7 ± 33.1</td><td>0.992</td></tr><tr><td> Serum creatinine (mg/dL)</td><td>1.3 ± 1.1</td><td>1.5 ± 1.6</td><td>0.617</td></tr><tr><td> Creatinine kinase (U/L)</td><td>23,159 ± 85,438</td><td>646 ± 2,239</td><td>0.342</td></tr><tr><td> Aspartate aminotransferase (U/L)</td><td>88 ± 76</td><td>92 ± 78</td><td>0.855</td></tr><tr><td> Alanine aminotransferase (U/L)</td><td>121 ± 151</td><td>112 ± 159</td><td>0.862</td></tr><tr><td> Lactate dehydrogenase (U/L)</td><td>1,104 ± 646</td><td>1,330 ± 1,403</td><td>0.554</td></tr><tr><td> C-reactive protein (mg/dL)</td><td>6.6 ± 4.3</td><td>6.5 ± 4.7</td><td>0.969</td></tr><tr><td>Electrolytes and FE</td><td></td><td></td><td></td></tr><tr><td> Sodium (mEq/L)</td><td>137.5 ± 4.6</td><td>136.6 ± 5.4</td><td>0.586</td></tr><tr><td> Potassium (mEq/L)</td><td>4.0 ± 0.4</td><td>4.0 ± 0.62</td><td>0.857</td></tr><tr><td> Calcium (mg/dL)</td><td>7.6 ± 0.4</td><td>7.6 ± 0.8</td><td>0.523</td></tr><tr><td> Phosphate (mg/dL)</td><td>3.3 ± 0.4</td><td>3.4 ± 0.7</td><td>0.860</td></tr><tr><td> FE<sub>UA</sub> (%)</td><td>40.14 ± 23.60</td><td>16.11 ± 11.38</td><td>0.005</td></tr><tr><td> FE of sodium (%)</td><td>0.68 ± 0.55</td><td>0.65 ± 0.94</td><td>0.895</td></tr><tr><td> FE of potassium (%)</td><td>9.20 ± 4.50</td><td>8.04 ± 5.30</td><td>0.472</td></tr><tr><td> Urine osmolarity (mOsmol/kgH<sub>2</sub>O)</td><td>431 ± 168</td><td>457 ± 211</td><td>0.710</td></tr></tbody></table><table-wrap-foot><fn><p>NOTE. Data represent the lowest observed level of serum UA. Values are expressed as means ± SD. To convert blood urea nitrogen in mg/dL to mmol/L, multiply by 0.357; serum creatinine in mg/dL to μmol/L, multiply by 88.4; sodium and potassium in mEq/L to mmol/L, multiply by 1; calcium in mg/dL to mmol/L, multiply by 0.2495; phosphate in mg/dL to mmol/L, multiply by 0.3229.</p></fn></table-wrap-foot></table-wrap></p></sec><sec><title>Excretion of uric acid</title><p>Forty-three patients (12 hypouricemic, 31 normouricemic) had urine samples available to calculate FE<sub>UA</sub> and electrolyte levels days 5 to 11 after fever onset. FE<sub>UA</sub> of the hypouricemic group was significantly greater than that of the normouricemic group (39.6% ± 23.4% versus 16.4% ± 11.4%; <italic>P</italic> < 0.0001). All hypouricemic patients had inappropriate uricosuria (FE<sub>UA</sub> > 10%). The inverse correlation of FE<sub>UA</sub> with serum UA level was significant (<italic>r</italic> = −0.565; <italic>P</italic> < 0.001; <xref rid="fig2" ref-type="fig">Fig 2</xref>). Three hypouricemic patients had a positive urine glucose test result detected with Multistix (Bayer, Taiwan), including 2 patients with diabetes with plasma glucose levels greater than 200 mg/dL (>11.1 mmol/L).<fig id="fig2"><label>Fig 2</label><caption><p>The relationship between serum UA level and FE<sub>UA</sub> in 43 patients with SARS. Dashed lines indicate FE<sub>UA</sub> of 10% (horizontal) and serum UA level of 2.5 mg/dL (149 μmol/L; vertical). To convert UA in mg/dL to μmol/L, multiply by 59.48.</p></caption><graphic xlink:href="gr2"></graphic></fig></p></sec><sec><title>Effects of uric acid on clinical outcomes</title><p>Most patients were treated with ribavirin, 1,200 mg/d; methylprednisolone, 2 mg/kg/d for 5 days; and, depending on the patient’s condition, intravenous immunoglobulin, 1 g/kg/d for 2 days.<xref rid="bib9" ref-type="bibr"><sup>9</sup></xref> There was no difference in treatment regimens between the 2 groups (<xref rid="tbl3" ref-type="table">Table 3</xref>). Logistic regression analysis did not show a significant correlation between serum UA levels and medication, except for a modest correlation between ribavirin treatment and FE<sub>UA</sub> (<italic>P</italic> = 0.074). There were no differences between the 2 groups in duration of fever, hospital stay, or incidence of ARF. However, more hypouricemic patients needed endotracheal intubation for ventilation support than normouricemic patients (<italic>P</italic> = 0.026; <xref rid="tbl3" ref-type="table">Table 3</xref>). Twenty patients underwent endotracheal intubation for mechanical ventilation, and their FE<sub>UA</sub> was greater than that of patients who did not undergo mechanical ventilation (<italic>P</italic> = 0.023; <xref rid="fig3" ref-type="fig">Fig 3</xref>).
<table-wrap position="float" id="tbl3"><label>Table 3</label><caption><p>Treatment and Clinical Outcomes</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center"></th><th align="center">Hypouricemia (n = 16)</th><th align="center">Normouricemia (n = 44)</th><th align="center"><italic>P</italic></th></tr></thead><tbody><tr><td>Treatment</td><td></td><td></td><td></td></tr><tr><td> Ribavirin</td><td align="char">12 (75)</td><td align="char">41 (93.18)</td><td>0.074</td></tr><tr><td> Methylprednisolone</td><td align="char">15 (93.75)</td><td align="char">39 (88.64)</td><td>0.488</td></tr><tr><td> Intravenous immunoglobulin</td><td align="char">11 (68.75)</td><td align="char">25 (56.81)</td><td>0.299</td></tr><tr><td>Clinical outcomes</td><td></td><td></td><td></td></tr><tr><td> Duration of fever (d)</td><td align="char">8.1 ± 4.7</td><td align="char">9.6 ± 3.8</td><td>0.224</td></tr><tr><td> Hospital stay (d)</td><td align="char">35.9 ± 31.4</td><td align="char">26.2 ± 24.7</td><td>0.261</td></tr><tr><td> ARF</td><td align="char">3 (18.75)</td><td align="char">8 (18.18)</td><td>0.614</td></tr><tr><td> Death</td><td align="char">5 (31.25)</td><td align="char">9 (20.45)</td><td>0.292</td></tr><tr><td> Endotracheal intubation</td><td align="char">9 (56.3)</td><td align="char">11 (25)</td><td>0.026</td></tr><tr><td> Death and/or intubation</td><td align="char">11 (69.8)</td><td align="char">12 (27.3)</td><td>0.005</td></tr></tbody></table><table-wrap-foot><fn><p>NOTE. Results expressed as number (percent) or mean ± SD.</p></fn></table-wrap-foot></table-wrap><fig id="fig3"><label>Fig 3</label><caption><p>FE<sub>UA</sub> of patients who did versus did not need endotracheal intubation. Lines indicate mean values for the 2 groups.</p></caption><graphic xlink:href="gr3"></graphic></fig></p><p>Five hypouricemic patients and 9 normouricemic patients died. Twenty-three patients in our cohort (38.3%) had catastrophic outcomes (endotracheal intubation and/or death). The number of catastrophic outcomes adjusted for older age and sex showed that hypouremic patients had an odds ratio of 10.57 (confidence interval, 2.33 to 47.98; <italic>P</italic> = 0.002). Kaplan-Meier curves for catastrophic outcome–free results showed significant differences between patients with normouricemia or hypouricemia (log rank <italic>P</italic> = 0.01; <xref rid="fig4" ref-type="fig">Fig 4</xref>).
<fig id="fig4"><label>Fig 4</label><caption><p>Kaplan-Meier survival estimates of patients with SARS according to hypouricemic and normouricemic groups; <italic>P</italic> = 0.01 by log-rank test.</p></caption><graphic xlink:href="gr4"></graphic></fig></p></sec><sec><title>Factors associated with increased uric acid excretion</title><p>FE<sub>UA</sub> correlated with peak creatine kinase level (<italic>P</italic> = 0.014; <italic>r</italic> = 0.376) measured within the first 15 days and with need for endotracheal intubation for supportive ventilation (<italic>P</italic> = 0.003; <italic>r</italic> = 0.448), but correlated negatively with blood oxygen saturation (<italic>P</italic> = 0.001; <italic>r</italic> = −0.624). After adjustments for age and sex, FE<sub>UA</sub> remained significantly associated with blood oxygen saturation (<italic>P</italic> = 0.001; <italic>r</italic> = −0.624; adjusted <italic>r</italic><sup>2</sup> = 0.389). Moreover, FE<sub>UA</sub> was greater in patients who needed endotracheal intubation for ventilation support than in those who did not (<italic>P</italic> = 0.003; <xref rid="fig4" ref-type="fig">Fig 4</xref>).</p><p>Serum levels of the proinflammatory cytokines IL-6, IL-8, and TNF-α were measured in 16 patients (6 hypouricemic, 10 normouricemic) during their UA excretion studies. IL-8 levels correlated significantly with FE<sub>UA</sub> (<italic>P</italic> < 0.001; <italic>r</italic> = 0.785) and inversely with serum UA level (<italic>P</italic> = 0.044; <italic>r</italic> = −0.509; <xref rid="fig5" ref-type="fig">Fig 5</xref>). However, similar correlations were not observed for either IL-6 or TNF-α level.<fig id="fig5"><label>Fig 5</label><caption><p>Relationships between FE<sub>UA</sub> and serum IL-6, IL-8, and TNF-α levels in 16 patients with SARS.</p></caption><graphic xlink:href="gr5"></graphic></fig></p></sec></sec><sec><title>Discussion</title><p>In our study, more than one fourth of patients with SARS had hypouricemia, a clinical feature not reported previously. Considering that ribavirin treatment may increase serum UA levels,<xref rid="bib17" ref-type="bibr"><sup>17</sup></xref> the incidence of hypouricemia in patients with SARS may be underestimated. All hypouricemic patients in the present study had inappropriate uricosuria. The inverse correlation between serum UA level and FE<sub>UA</sub> indicates that the hypouricemia in patients with SARS resulted from an abnormal increase in UA excretion during SARS-CoV infection. Although SARS-CoV could be detected in patients’ urine, most of the patients with SARS we studied had normal renal function. Acute interstitial nephritis has been associated with various viral infections, but not reported in SARS-CoV infection. We had reported 2 necropsy cases of patients with SARS with ARF and did not find glomerular or tubular lesions.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref></p><p>Several diseases or factors may cause renal hypouricemia, eg, obstructive jaundice, solid or hematologic neoplasias, diabetes mellitus, and drugs affecting urate homeostasis.<xref rid="bib14" ref-type="bibr"><sup>14</sup></xref> Renal hypouricemia associated with infections has been reported infrequently.<xref rid="bib18" ref-type="bibr">18</xref>, <xref rid="bib19" ref-type="bibr">19</xref> Although a substantial proportion of patients with acquired immunodeficiency syndrome have presented with renal hypouricemia, co-trimoxazole was thought to be a contributory factor.<xref rid="bib19" ref-type="bibr">19</xref>, <xref rid="bib20" ref-type="bibr">20</xref> Causes of renal hypouricemia in patients with other systemic infections are not known.</p><p>Four complementary DNAs that express proteins transporting urate recently have been cloned.<xref rid="bib21" ref-type="bibr"><sup>21</sup></xref> Mutational defects of URAT1 (SLC22A12) have been identified in patients with renal hypouricemia,<xref rid="bib22" ref-type="bibr">22</xref>, <xref rid="bib23" ref-type="bibr">23</xref> but the mechanisms of urate transport regulation are not fully understood. Although proinflammatory cytokine data were obtained from a small proportion of our patients with SARS, it is interesting that serum IL-8 level correlated significantly with FE<sub>UA</sub>. It has been shown that proinflammatory cytokines can influence UA excretion<xref rid="bib24" ref-type="bibr"><sup>24</sup></xref> and modulate the activities of channels and transporters by various mechanisms.<xref rid="bib25" ref-type="bibr">25</xref>, <xref rid="bib26" ref-type="bibr">26</xref> To our knowledge, the effect of cytokines on urate transport has not been investigated. Previous reports indicated that the mean time for immunoglobulin G seroconversion of SARS-CoV occurs on day 10,<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref> accompanied by a decline in serum levels of such proinflammatory cytokines as IL-6, IL-8, and TNF-α in the convalescent stage.<xref rid="bib27" ref-type="bibr"><sup>27</sup></xref> Our study showed that the lowest serum UA level occurred days 7 to 9 after fever onset, when the cytokine storm of patients with SARS usually occurred.<xref rid="bib27" ref-type="bibr"><sup>27</sup></xref></p><p>Hypouricemia is a poor prognostic indicator in patients with intra-abdominal sepsis<xref rid="bib18" ref-type="bibr"><sup>18</sup></xref> or radiating pneumonitis.<xref rid="bib28" ref-type="bibr"><sup>28</sup></xref> In patients with acquired immunodeficiency syndrome with infections of the central nervous system, renal hypouricemia also is an ominous sign.<xref rid="bib19" ref-type="bibr"><sup>19</sup></xref> The present study shows that hypouricemic patients with SARS had a poor outcome, especially in terms of respiratory failure, compared with normouricemic patients. Moreover, Kaplan-Meier curves for catastrophic outcome–free results showed significant differences between patients with normouricemia or hypouricemia. In addition, FE<sub>UA</sub> correlated inversely with blood oxygenation. UA is the main metabolite of adenosine triphosphate degradation, and increased UA excretion has been observed in patients with respiratory failure.<xref rid="bib29" ref-type="bibr"><sup>29</sup></xref> However, in such patients, serum UA levels were not decreased or changed by treatment,<xref rid="bib29" ref-type="bibr"><sup>29</sup></xref> implicating increased UA production, rather than abnormal UA renal handling, in hypoxic patients. We speculate that both hypoxia and hypouricemia in patients with SARS indicate the severity of SARS-CoV infection, which affects both ventilation and UA excretion. In vivo and in vitro studies<xref rid="bib30" ref-type="bibr">30</xref>, <xref rid="bib31" ref-type="bibr">31</xref> have shown UA to be an important antioxidant, contributing as much as 60% of free-radical scavenging in human serum.<xref rid="bib32" ref-type="bibr"><sup>32</sup></xref> A prospective, randomized, controlled clinical trial showed that a nucleotide-supplemented diet could significantly reduce complications and shorten hospital stay after admission to an intensive care unit,<xref rid="bib33" ref-type="bibr"><sup>33</sup></xref> suggesting serum UA as a possible surrogate of antioxidant capacity.<xref rid="bib34" ref-type="bibr"><sup>34</sup></xref> It is not clear whether poor outcomes of hypouricemic patients with SARS are caused in part by a shortage of antioxidants.</p><p>In summary, hypouricemia resulting from abnormal renal urate handling is not rare in patients with SARS-CoV infection and may reflect the severity of disease and predict poor patient outcomes. The significance of the relationship between IL-8 level and FE<sub>UA</sub> needs further investigation.</p></sec></body><back><ref-list><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ksiazek</surname><given-names>T.G.</given-names></name><name><surname>Erdman</surname><given-names>D.</given-names></name><name><surname>Goldsmith</surname><given-names>C.S.</given-names></name></person-group><article-title>A novel coronavirus associated with severe acute respiratory syndrome</article-title><source>N Engl J Med</source><volume>348</volume><year>2003</year><fpage>1953</fpage><lpage>1966</lpage><pub-id pub-id-type="pmid">12690092</pub-id></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Peiris</surname><given-names>J.S.</given-names></name><name><surname>Chu</surname><given-names>C.M.</given-names></name><name><surname>Cheng</surname><given-names>V.C.</given-names></name></person-group><article-title>Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: A prospective study</article-title><source>Lancet</source><volume>361</volume><year>2003</year><fpage>1767</fpage><lpage>1772</lpage><pub-id pub-id-type="pmid">12781535</pub-id></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Tsai</surname><given-names>H.B.</given-names></name><name><surname>Huang</surname><given-names>J.W.</given-names></name><name><surname>Chen</surname><given-names>K.Y.</given-names></name></person-group><source>Acute renal failure and renal replacement therapy in SARS patients. Presented at the Annual Committee on American Society of Nephrology, San Diego, CA, November 12–17</source><year>2003</year><comment>(abstr)</comment></element-citation></ref><ref id="bib4"><label>4</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Wu</surname><given-names>V.C.</given-names></name><name><surname>Hsueh</surname><given-names>P.R.</given-names></name><name><surname>Lin</surname><given-names>W.C.</given-names></name></person-group><source>Acute renal failure in SARS patients: More than rhabdomyolysis</source><year>2003</year><comment>Presented at the 20th Annual Committee on Taiwan Society of Nephrology, Taipei, Taiwan, December 13–14 (abstr)</comment></element-citation></ref><ref id="bib5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vas</surname><given-names>S.I.</given-names></name></person-group><article-title>Primary and secondary role of viruses in chronic renal failure</article-title><source>Kidney Int Suppl</source><volume>35</volume><year>1991</year><fpage>S2</fpage><lpage>S4</lpage><pub-id pub-id-type="pmid">1770707</pub-id></element-citation></ref><ref id="bib6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Glassock</surname><given-names>R.J.</given-names></name></person-group><article-title>Immune complex-induced glomerular injury in viral diseases: An overview</article-title><source>Kidney Int Suppl</source><volume>35</volume><year>1991</year><fpage>S5</fpage><lpage>S7</lpage><pub-id pub-id-type="pmid">1837573</pub-id></element-citation></ref><ref id="bib7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maesaka</surname><given-names>J.K.</given-names></name><name><surname>Cusano</surname><given-names>A.J.</given-names></name><name><surname>Thies</surname><given-names>H.L.</given-names></name></person-group><article-title>Hypouricemia in acquired immunodeficiency syndrome</article-title><source>Am J Kidney Dis</source><volume>15</volume><year>1990</year><fpage>252</fpage><lpage>257</lpage><pub-id pub-id-type="pmid">2305765</pub-id></element-citation></ref><ref id="bib8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ogino</surname><given-names>K.</given-names></name><name><surname>Hisatome</surname><given-names>I.</given-names></name><name><surname>Saitoh</surname><given-names>M.</given-names></name></person-group><article-title>Clinical significance of hypouricemia in hospitalized patients</article-title><source>J Med</source><volume>22</volume><year>1991</year><fpage>76</fpage><lpage>82</lpage><pub-id pub-id-type="pmid">1895016</pub-id></element-citation></ref><ref id="bib9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>J.T.</given-names></name><name><surname>Wang</surname><given-names>J.L.</given-names></name><name><surname>Fang</surname><given-names>C.T.</given-names></name><name><surname>Chang</surname><given-names>S.C.</given-names></name></person-group><article-title>Early defervescence and SARS recovery</article-title><source>Emerg Infect Dis</source><volume>10</volume><year>2004</year><fpage>544</fpage><lpage>545</lpage><pub-id pub-id-type="pmid">15116707</pub-id></element-citation></ref><ref id="bib10"><label>10</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>World Health Organization</collab></person-group><source>Case Definitions for Surveillance of Severe Acute Respiratory Syndrome (SARS)</source><year>2003</year><comment>Available at: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/csr/don/2003_04_19/en/">http://www.who.int/csr/don/2003_04_19/en/</ext-link>. Accessed: May 5</comment></element-citation></ref><ref id="bib11"><label>11</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>Centers for Disease Control and Prevention</collab></person-group><source>SARS Coronavirus Sequencing</source><year>2003</year><comment>Available at: <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov.ncidod/sars/sequence.htm">http://www.cdc.gov.ncidod/sars/sequence.htm</ext-link>. Accessed: April 14</comment></element-citation></ref><ref id="bib12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>J.T.</given-names></name><name><surname>Sheng</surname><given-names>W.H.</given-names></name><name><surname>Fang</surname><given-names>C.T.</given-names></name></person-group><article-title>Clinical manifestations, laboratory findings, and treatment outcomes of SARS patients</article-title><source>Emerg Infect Dis</source><volume>10</volume><year>2004</year><fpage>818</fpage><lpage>824</lpage><pub-id pub-id-type="pmid">15200814</pub-id></element-citation></ref><ref id="bib13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maesaka</surname><given-names>J.K.</given-names></name><name><surname>Fishbane</surname><given-names>S.</given-names></name></person-group><article-title>Regulation of renal urate excretion: A critical review</article-title><source>Am J Kidney Dis</source><volume>32</volume><year>1998</year><fpage>917</fpage><lpage>933</lpage><pub-id pub-id-type="pmid">9856507</pub-id></element-citation></ref><ref id="bib14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bairaktari</surname><given-names>E.T.</given-names></name><name><surname>Kakafika</surname><given-names>A.I.</given-names></name><name><surname>Pritsivelis</surname><given-names>N.</given-names></name></person-group><article-title>Hypouricemia in individuals admitted to an inpatient hospital-based facility</article-title><source>Am J Kidney Dis</source><volume>41</volume><year>2003</year><fpage>1225</fpage><lpage>1232</lpage><pub-id pub-id-type="pmid">12776275</pub-id></element-citation></ref><ref id="bib15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bairaktari</surname><given-names>E.</given-names></name><name><surname>Liamis</surname><given-names>G.</given-names></name><name><surname>Tsolas</surname><given-names>O.</given-names></name><name><surname>Elisaf</surname><given-names>M.</given-names></name></person-group><article-title>Partially reversible renal tubular damage in patients with obstructive jaundice</article-title><source>Hepatology</source><volume>33</volume><year>2001</year><fpage>1365</fpage><lpage>1369</lpage><pub-id pub-id-type="pmid">11391524</pub-id></element-citation></ref><ref id="bib16"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Booth</surname><given-names>C.M.</given-names></name><name><surname>Matukas</surname><given-names>L.M.</given-names></name><name><surname>Tomlinson</surname><given-names>G.A.</given-names></name></person-group><article-title>Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area</article-title><source>JAMA</source><volume>289</volume><year>2003</year><fpage>2801</fpage><lpage>2809</lpage><pub-id pub-id-type="pmid">12734147</pub-id></element-citation></ref><ref id="bib17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moreno-Monteagudo</surname><given-names>J.A.</given-names></name><name><surname>Fernandez-Bermejo</surname><given-names>M.</given-names></name><name><surname>Garcia-Buey</surname><given-names>L.</given-names></name></person-group><article-title>Interferon alpha with ribavirin for the treatment of chronic hepatitis C in non-responders or relapsers to interferon monotherapy</article-title><source>Aliment Pharmacol Ther</source><volume>12</volume><year>1998</year><fpage>717</fpage><lpage>723</lpage><pub-id pub-id-type="pmid">9726383</pub-id></element-citation></ref><ref id="bib18"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Abou-Mourad</surname><given-names>N.N.</given-names></name><name><surname>Chamberlain</surname><given-names>B.E.</given-names></name><name><surname>Ackerman</surname><given-names>N.B.</given-names></name></person-group><article-title>Poor prognosis of patients with intra-abdominal sepsis and hypouricemia</article-title><source>Surg Gynecol Obstet</source><volume>148</volume><year>1979</year><fpage>358</fpage><lpage>360</lpage><pub-id pub-id-type="pmid">419435</pub-id></element-citation></ref><ref id="bib19"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Collazos</surname><given-names>J.</given-names></name><name><surname>Blanco</surname><given-names>M.S.</given-names></name><name><surname>Guerra</surname><given-names>E.</given-names></name></person-group><article-title>Sequential evaluation of serum urate concentrations in AIDS patients with infections of the central nervous system</article-title><source>Clin Chem Lab Med</source><volume>38</volume><year>2000</year><fpage>1293</fpage><lpage>1296</lpage><pub-id pub-id-type="pmid">11205696</pub-id></element-citation></ref><ref id="bib20"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chertow</surname><given-names>G.M.</given-names></name><name><surname>Seifter</surname><given-names>J.L.</given-names></name><name><surname>Christiansen</surname><given-names>C.L.</given-names></name><name><surname>O’Donnell</surname><given-names>W.J.</given-names></name></person-group><article-title>Trimethoprim-sulfamethoxazole and hypouricemia</article-title><source>Clin Nephrol</source><volume>46</volume><year>1996</year><fpage>193</fpage><lpage>198</lpage><pub-id pub-id-type="pmid">8879855</pub-id></element-citation></ref><ref id="bib21"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rafey</surname><given-names>M.A.</given-names></name><name><surname>Lipkowitz</surname><given-names>M.S.</given-names></name><name><surname>Leal-Pinto</surname><given-names>E.</given-names></name><name><surname>Abramson</surname><given-names>R.G.</given-names></name></person-group><article-title>Uric acid transport</article-title><source>Curr Opin Nephrol Hypertens</source><volume>12</volume><year>2003</year><fpage>511</fpage><lpage>516</lpage><pub-id pub-id-type="pmid">12920398</pub-id></element-citation></ref><ref id="bib22"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Enomoto</surname><given-names>A.</given-names></name><name><surname>Kimura</surname><given-names>H.</given-names></name><name><surname>Chairoungdua</surname><given-names>A.</given-names></name></person-group><article-title>Molecular identification of a renal urate anion exchanger that regulates blood urate levels</article-title><source>Nature</source><volume>417</volume><year>2002</year><fpage>447</fpage><lpage>452</lpage><pub-id pub-id-type="pmid">12024214</pub-id></element-citation></ref><ref id="bib23"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ichida</surname><given-names>K.</given-names></name><name><surname>Hosoyamada</surname><given-names>M.</given-names></name><name><surname>Hisatome</surname><given-names>I.</given-names></name></person-group><article-title>Clinical and molecular analysis of patients with renal hypouricemia in Japan—Influence of URAT1 gene on urinary urate excretion</article-title><source>J Am Soc Nephrol</source><volume>15</volume><year>2004</year><fpage>164</fpage><lpage>173</lpage><pub-id pub-id-type="pmid">14694169</pub-id></element-citation></ref><ref id="bib24"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Urano</surname><given-names>W.</given-names></name><name><surname>Yamanaka</surname><given-names>H.</given-names></name><name><surname>Tsutani</surname><given-names>H.</given-names></name></person-group><article-title>The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis</article-title><source>J Rheumatol</source><volume>29</volume><year>2002</year><fpage>1950</fpage><lpage>1953</lpage><pub-id pub-id-type="pmid">12233891</pub-id></element-citation></ref><ref id="bib25"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Puma</surname><given-names>C.</given-names></name><name><surname>Danik</surname><given-names>M.</given-names></name><name><surname>Quirion</surname><given-names>R.</given-names></name></person-group><article-title>The chemokine interleukin-8 acutely reduces Ca(2+) currents in identified cholinergic septal neurons expressing CXCR1 and CXCR2 receptor mRNAs</article-title><source>J Neurochem</source><volume>78</volume><year>2001</year><fpage>960</fpage><lpage>971</lpage><pub-id pub-id-type="pmid">11553670</pub-id></element-citation></ref><ref id="bib26"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Qiu</surname><given-names>M.R.</given-names></name><name><surname>Campbell</surname><given-names>T.J.</given-names></name><name><surname>Breit</surname><given-names>S.N.</given-names></name></person-group><article-title>A potassium ion channel is involved in cytokine production by activated human macrophages</article-title><source>Clin Exp Immunol</source><volume>130</volume><year>2002</year><fpage>67</fpage><lpage>74</lpage><pub-id pub-id-type="pmid">12296855</pub-id></element-citation></ref><ref id="bib27"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hsueh</surname><given-names>P.R.</given-names></name><name><surname>Chen</surname><given-names>P.J.</given-names></name><name><surname>Hsiao</surname><given-names>C.H.</given-names></name></person-group><article-title>Patient data, early SARS epidemic, Taiwan</article-title><source>Emerg Infect Dis</source><volume>10</volume><year>2004</year><fpage>489</fpage><lpage>493</lpage><pub-id pub-id-type="pmid">15109419</pub-id></element-citation></ref><ref id="bib28"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>J.Y.</given-names></name><name><surname>Chen</surname><given-names>K.Y.</given-names></name><name><surname>Wang</surname><given-names>J.T.</given-names></name></person-group><article-title>Outcome and prognostic factors for patients with non-small-cell lung cancer and severe radiation pneumonitis</article-title><source>Int J Radiat Oncol Biol Phys</source><volume>54</volume><year>2002</year><fpage>735</fpage><lpage>741</lpage><pub-id pub-id-type="pmid">12377325</pub-id></element-citation></ref><ref id="bib29"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sahebjami</surname><given-names>H.</given-names></name></person-group><article-title>Changes in urinary uric acid excretion in obstructive sleep apnea before and after therapy with nasal continuous positive airway pressure</article-title><source>Chest</source><volume>113</volume><year>1998</year><fpage>1604</fpage><lpage>1608</lpage><pub-id pub-id-type="pmid">9631800</pub-id></element-citation></ref><ref id="bib30"><label>30</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hink</surname><given-names>H.U.</given-names></name><name><surname>Santanam</surname><given-names>N.</given-names></name><name><surname>Dikalov</surname><given-names>S.</given-names></name></person-group><article-title>Peroxidase properties of extracellular superoxide dismutase: Role of uric acid in modulating in vivo activity</article-title><source>Arterioscler Thromb Vasc Biol</source><volume>22</volume><year>2002</year><fpage>1402</fpage><lpage>1408</lpage><pub-id pub-id-type="pmid">12231557</pub-id></element-citation></ref><ref id="bib31"><label>31</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ames</surname><given-names>B.N.</given-names></name><name><surname>Cathcart</surname><given-names>R.</given-names></name><name><surname>Schwiers</surname><given-names>E.</given-names></name><name><surname>Hochstein</surname><given-names>P.</given-names></name></person-group><article-title>Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: A hypothesis</article-title><source>Proc Natl Acad Sci U S A</source><volume>78</volume><year>1981</year><fpage>6858</fpage><lpage>6862</lpage><pub-id pub-id-type="pmid">6947260</pub-id></element-citation></ref><ref id="bib32"><label>32</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maxwell</surname><given-names>S.R.</given-names></name><name><surname>Thomason</surname><given-names>H.</given-names></name><name><surname>Sandler</surname><given-names>D.</given-names></name></person-group><article-title>Antioxidant status in patients with uncomplicated insulin-dependent and non-insulin-dependent diabetes mellitus</article-title><source>Eur J Clin Invest</source><volume>27</volume><year>1997</year><fpage>484</fpage><lpage>490</lpage><pub-id pub-id-type="pmid">9229228</pub-id></element-citation></ref><ref id="bib33"><label>33</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bower</surname><given-names>R.H.</given-names></name><name><surname>Cerra</surname><given-names>F.B.</given-names></name><name><surname>Bershadsky</surname><given-names>B.</given-names></name></person-group><article-title>Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial</article-title><source>Crit Care Med</source><volume>23</volume><year>1995</year><fpage>436</fpage><lpage>449</lpage><pub-id pub-id-type="pmid">7874893</pub-id></element-citation></ref><ref id="bib34"><label>34</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hsu</surname><given-names>S.P.</given-names></name><name><surname>Pai</surname><given-names>M.F.</given-names></name><name><surname>Peng</surname><given-names>Y.S.</given-names></name></person-group><article-title>Serum uric acid levels show a ’J-shaped’ association with all-cause mortality in haemodialysis patients</article-title><source>Nephrol Dial Transplant</source><volume>19</volume><year>2004</year><fpage>457</fpage><lpage>462</lpage><pub-id pub-id-type="pmid">14736974</pub-id></element-citation></ref></ref-list><ack><title>Acknowledgment</title><p>The authors thank Ming-Yi Chung for technical support and Dr Tzi-Yi Chuang for help in data collection.</p></ack><fn-group><fn id="d32e1374"><p>The SARS Research Group of National Taiwan University College of Medicine and National Taiwan University Hospital includes the following members: Ding-Shinn Chen, Yuan-Teh Lee, Che-Ming Teng, Pan-Chyr Yang, Hong-Nerng Ho, Pei-Jer Chen, Ming-Fu Chang, Jin-Town Wang, Shan-Chwen Chang, Chuan-Liang Kao, Wei-Kung Wang, Cheng-Hsiang Hsiao, and Po-Ren Hsueh.</p></fn><fn id="d32e1376"><p>Supported in part by the Improving Dialysis Quality Research Funds and Ta-Tung Kidney Foundation.</p></fn></fn-group></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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