Б
том ХXXI, 2025, № 2
ДРУЖЕСТВО
НА КАРДИОЛОЗИТЕ
В БЪЛГАРИЯ
АВТОРСКИ СТАТИИ
ORIGINAL ARTICLES
URIC ACID/ALBUMIN RATIO AS A NOVEL BIOMARKER FOR PREDICTING POOR
URIC ACID/ALBUMIN RATIO AS A NOVEL BIOMARKER FOR PREDICTING POOR
CORONARY COLLATERAL CIRCULATION IN CORONARY ARTERY DISEASE:
CORONARY COLLATERAL CIRCULATION IN CORONARY ARTERY DISEASE:
META-ANALYSIS STUDY
META-ANALYSIS STUDY
F. Fa abi1, M. N.A i a2, P. Puspawikan1, B. B. Tiksnadi1
1Depa men o Ca diology and Vascula Medicine, Facul y o Medicine, Uni e si y Padjadja an
2Facul y o Medicine, Uni e si y Indonesia – Jaka a, Indonesia
СЪОТНОШЕНИЕТО МЕЖДУ ПИКОЧНА КИСЕЛИНА И АЛБУМИН КАТО
СЪОТНОШЕНИЕТО МЕЖДУ ПИКОЧНА КИСЕЛИНА И АЛБУМИН КАТО
НОВ БИОМАРКЕР ЗА ПРОГНОЗИРАНЕ НА ЛОША КОРОНАРНА КОЛАТЕРАЛНА
НОВ БИОМАРКЕР ЗА ПРОГНОЗИРАНЕ НА ЛОША КОРОНАРНА КОЛАТЕРАЛНА
ЦИРКУЛАЦИЯ ПРИ ИСХЕМИЧНА БОЛЕСТ НА СЪРЦЕТО: МЕТААНАЛИЗ
ЦИРКУЛАЦИЯ ПРИ ИСХЕМИЧНА БОЛЕСТ НА СЪРЦЕТО: МЕТААНАЛИЗ
Ф. Фараби1, М. Н. Афифа2, П. Пуспавикан1, Б. Б. Тикснади1
1Катедра по кардиология и съдова медицина, Медицински факултет,
Университет Паджаджаран – Бандунг, Индонезия
2Медицински факултет, Университет Индонезия – Джакарта, Индонезия
Abs ac . Backg ound: Co ona y colla e al plays a ole in main aining myoca dial unc ion, limi ing in a c size, and educed
mo bidi y and mo ali y. U ic acid o albumin a io (UAR) has ecen ly been disco e ed as a no el bioma ke associa ed
wi h ca dio ascula disease. Howe e , s udies in es iga ing he ela ionship be ween UAR and co ona y colla e al
ci cula ion (CCC) o ma ion a e limi ed and ha e low magni ude. The e o e, his s udy aims o de e mine he ela ionship
be ween UAR and CCC o ma ion in co ona y a e y disease pa ien s. Me hods: The li e a u e was sea ched in PubMed,
Medline, Sp inge Link, ScienceDi ec , and Scopus o a icles published be o e Augus 2024. S udies ha did no epo
UAR esul s as one o he pa ame e s bu included u ic acid and albumin in hei labo a o y pa ame e s, had UAR alues
calcula ed using he e o p opaga ion o a io o mula. S a is ical analysis o me a-analysis using Re iew Manage 5.4
so wa e o e alua e he ela ionship be ween UAR and CCC. Resul s: A sys ema ic sea ch e ie ed nine s udies ha
me he eligibili y c i e ia. The o al popula ion in hese s udies was 5290 subjec s, including 3744 subjec s wi h good
co ona y colla e al ci cula ion and 1546 subjec s wi h poo co ona y ci cula ion. Fou o he nine s udies assessed albumin
pa ame e s using glyca ed albumin and one s udy assessed albumin pa ame e s using ischemic modi i ed albumin. The
u ic acid/albumin a io is co ela ed wi h CCC o ma ion, wi h he lowe he UAR, he mo e likely CCC o ma ion will occu
(SMD -0.31, 95% CI -0.56 o -0.05, p- alue 0.02, I2 93%). In he subanalysis o he di e en pa ame e s, u ic acid is also
co ela ed wi h CCC o ma ion (SMD -0.41, 95% CI -0.74 o -0.08, p- alue 0.01, I2 96%), while albumin has no s ong
co ela ion. Conclusion: U ic acid o albumin a io could be a new pa ame e in p edic ing he o ma ion o co ona y
colla e al ci cula ion in pa ien s wi h s able co ona y a e y disease.
Key wo d: albumin, CAD, co ona y colla e al ci cula ion, u ic acid
Add ess
o co espondence:
Fa ih Fa abi, MD, Depa men o Ca diology and Vascula Medicine, Uni e si y Padjadja an, Bandung, Indonesia,
e-mail: [email p o ec ed]
Резюме.Въведение: Колатералите на коронарните съдове играят роля за поддържането на миокардната функция, огра-
ничаването на размера на инфаркта и намалената заболяемост и смъртност. Съотношението пикочна киселина/
албумин (UAR) наскоро е открито като нов биомаркер, свързан със сърдечно-съдовите заболявания. Въпреки това
проучванията, изследващи връзката между UAR и формирането на коронарна колатерална циркулация, са ограни-
чени и с ниска значимост. Това проучване цели да се определи връзката между UAR и формирането на коронарна
колатерална циркулация при пациенти с коронарна артериална болест. Методи: Проведено е литературно търсе-
не в PubMed, Medline, Sp inge Link, ScienceDi ec и Scopus на статии, публикувани преди август 2024 г. За проучва-
нията, които не докладват резултати за UAR като един от параметрите, но включват пикочна киселина и албумин в
лабораторните си параметри, стойностите на UAR са изчислени с помощта на формула за разпространение
This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (CC BY 4.0), which pe mi s un es ic ed
use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal au ho and sou ce a e c edi ed.
doi: 10.3897/bgca dio.31.e142199
F. Fa abi, M. N.A i a, P. Puspawikan, B. B. Tiksnadi
100
B
Co ona y a e y disease (CAD) is caused by na -
owing o he co ona y a e ies, which leads o isch-
emia. The educed oxygen supply causes he hea
muscle o wo k a subop imal le els [1, 2]. In ischemic
condi ions, co ona y blood essels gene a e addi ional
blood l ow o educe ischemia, called colla e al ci cu-
la ion. Co ona y colla e al a e ies o igina e om o he
co ona y a e ies wi h be e blood l ow o help pe use
he ischemic egion o he hea [3]. The p ocess o co -
ona y colla e al o ma ion begins wi h he mechanism
o l uid shea s ess a he endo helial le el and he
p esence o ischemia-induced in l amma o y ac o s.
Co ona y colla e al plays a ole in main aining myoca -
dial unc ion, limi ing in a c size, and educed mo bidi-
y and mo ali y [4, 5].
In l amma ion is a con ibu ing ac o o colla e -
al o ma ion. U ic acid is a pa ame e ha has been
ound o be associa ed wi h in l amma o y condi ions.
Se um u ic acid is he end p oduc o pu ine me ab-
olism. U ic acid plays a ole in he in l amma o y p o-
cess and may impai ascula endo helial unc ion [6,
7]. U ic acid has been associa ed wi h ca dio ascula
disease and i s p ognosis. Hype ension, hea ail-
u e, CAD, and a hy hmias a e some o he ca dio-
ascula diseases associa ed wi h ele a ed u ic acid
[8]. Meanwhile, albumin is one o he pa ame e s in
he blood ha has an i-in l amma o y and p o ec i e
eff ec s agains oxida i e s ess [9, 10] Hypoalbu-
minemia is associa ed wi h inc eased mo ali y and
incidence o ca dio ascula disease [11]. The e o e,
u ic acid and albumin ha e opposi e eff ec s on ca -
dio ascula disease.
U ic acid o albumin a io (UAR) has ecen ly been
disco e ed as a no el bioma ke associa ed wi h ca -
dio ascula disease. Highe UAR le els a e associa ed
wi h inc eased se e i y in CAD pa ien s [12, 13] How-
e e , s udies in es iga ing he ela ionship be ween
UAR and CCC o ma ion a e limi ed and ha e low
magni ude. The e o e, his s udy aims o de e mine he
ela ionship be ween UAR and CCC o ma ion in co o-
na y a e y disease pa ien s.
M
S udy Design and Li e a u e Sea ch
This s udy was egis e ed a he In e na ional P o-
spec i e Regis e o Sys ema ic Re iews (PROSPE-
RO) wi h he egis a ion numbe CRD42024575003.
The li e a u e was sea ched in PubMed, Medline,
Sp inge Link, ScienceDi ec , and Scopus o a icles
published be o e Augus 2024. The sea ch used he
keywo ds “acu e myoca dial in a c ion”, “u ic acid”, “al-
bumin”, and “co ona y colla e al ci cula ion”. The de-
ailed key wo ds used a e lis ed in he Table 1.
Table 1. Sea ch keywo ds in he da abase
Da abase Key wo d
PubMed, Medline,
ScienceDi ec , Scopus
(“Co ona y A e y Disease*” OR
“CAD” OR “A he osle o*” OR
“Co ona y A he oscle o*” OR “Ch onic
o al occlu*”) AND (“U ic Acid” OR
“Albumin” OR “U ic Acid o Albumin
Ra io” OR “U ic Acid o Albumin” OR
“U ic Acid/Albumin” OR “UAR”) AND
(“Co ona y Colla e al Ci cula ion*” OR
“CCC” OR “Ren op” OR “Co ona y
Colla e aliza ion” OR “Co ona y
Colla e al*” OR “Colla e al Index”)
Sp inge Link (“U ic Acid o Albumin Ra io” OR “U ic
Acid o Albumin” OR “UAR”) AND
(“Co ona y Colla e al Ci cula ion” OR
“CCC” OR “Ren op” OR “Co ona y
Colla e aliza ion” OR “Colla e al Index”)
на грешките за формулата на съотношението. Статистическия анализ в този метаанализ е извършен чрез софту-
ер Re iew Manage 5.4, за да се оцени връзката между UAR и коронарната колатерална циркулация. Резултати:
Чрез систематичното търсене се откриха 9 проучвания, отговарящи на критериите за допустимост. Общата попу-
лация в тези проучвания е 5290 лица, вкл. 3744 лица с добра коронарна колатерална циркулация и 1546 с лоша
коронарна циркулация. В 4 от 9 проучвания албуминовите параметри се оценяват чрез гликирания албумин и в
1 проучване – чрез исхемично модифициран албумин. Съотношението пикочна киселина/албумин корелира с
формирането на коронарна колатерална циркулация, като колкото по-ниско е UAR, толкова по-вероятно е образу-
ването на коронарна колатерална циркулация (SMD -0,31, 95% CI -0,56 до -0,05, p-стойност 0,02, I2 93%). При по-
данализа на различните параметри пикочната киселина също корелира с формирането на коронарна колатерална
циркулация (SMD -0,41, 95% CI -0,74 до -0,08, p-стойност 0,01, I2 96%), докато албуминът няма силна корелация.
Заключение: Съотношението пикочна киселина/албумин може да е нов параметър за прогнозиране на формира-
нето на коронарна колатерална циркулация при пациенти със стабилна коронарна артериална болест.
Ключови думи:албумин, коронарна артериална болест (исхемична болест на сърцето), коронарна колатерална циркулация,
пикочна киселина
Адрес
за кореспонденция:
д-р Фатих Фараби, Катедра по кардиология и съдова медицина, Университет Паджаджаран, Бандунг, Индонезия,
e-mail: [email p o ec ed]
101
U ic acid/albumin a io as a no el bioma ke o p edic ing...
Eligibili y C i e ia
Inclusion c i e ia o his s udy we e s udies wi h
a popula ion o pa ien s wi h ch onic s able co ona y
a e y disease wi h o wi hou ch onic o al occlusion
who we e measu ed o albumin and u ic acid wi h
he ou come o co ona y colla e al ci cula ion. Gly-
ca ed albumin and ischemia-modi i ed albumin mea-
su emen s we e also included in his s udy. Co ona y
colla e al ci cula ion was assessed using he Ren op
classi i ca ion, whe e g ades 0-1 ep esen poo co -
ona y colla e al ci cula ion and 2-3 ep esen good
co ona y colla e al ci cula ion. The s udy designs in-
cluded in his s udy we e c oss-sec ional, coho , and
case-con ol. Manusc ip s ha a e no published in
English and a e no a ailable as ull pape s will be
excluded om his s udy.
Da a Ex ac ion
Eligible s udies and hose included in his s udy
we e sc eened by wo independen e iewe s, who
ini ially sc eened he abs ac and i le. In case o dis-
ag eemen be ween he wo e iewe s, he decision
was aken by a hi d pe son wi h highe compe ence in
he ca dio ascula i eld.
Quali y Assessmen
Risk o bias was assessed using he Joanna B iggs
Ins i u e (JBI) C i ical App aisal Checklis o Analy ical
C oss-Sec ional S udies. This assessmen was pe -
o med by wo independen e iewe s. The pa ame e s
assessed consis ed o eigh ques ions. The in e p e a-
ion o he alue is i i has a alue o mo e han 70% is
conside ed low isk ca ego y, 50% - 70% is conside ed
mode a e isk and less han 50% is conside ed high
isk [14].
Ou come o In e es
The p ima y ou come o his s udy is o i nd he
co ela ion be ween u ic acid o albumin a io o p e-
dic co ona y colla e al o ma ion in pa ien s wi h s a-
ble co ona y a e y disease. The seconda y ou come
o his s udy is he co ela ion be ween each u ic acid
and albumin on he de elopmen o co ona y colla e al
ci cula ion.
S a is ical Analysis
S udies ha did no epo UAR esul s as one o
he pa ame e s bu included u ic acid and albumin in
hei labo a o y pa ame e s, had UAR alues calcu-
la ed. The UAR was calcula ed based on he mean ±
s anda d de ia ion da a o u ic acid and albumin us-
ing he e o p opaga ion o a io o mula. When he
s udies do no p o ide mean and s anda d de ia ion
da a, i will be es ima ed using median and pe cen-
ile ( i s and hi d qua ile) [15, 16]. S a is ical anal-
ysis o me a-analysis using Re iew Manage 5.4
so wa e o e alua e he ela ionship be ween UAR
and CCC o ma ion using he eff ec measu e s an-
da d mean diff e ence. Random eff ec model is used
because he uni s o measu emen o u ic acid and
albumin examina ion a e no he same be ween each
s udy. He e ogenei y is assessed using he I2 alue,
which indica es ha i I2 > 50% and p alue < 0.1,
he he e ogenei y ca ego y is high. Publica ion bias
was measu ed using unnel plo s and Egge ’s es
which was analyzed wi h IBM Co p. Released 2023.
IBM SPSS S a is ics o Windows, Ve sion 29.0.2.0
A monk, NY: IBM Co p.
R
A sys ema ic sea ch conduc ed in acco dance wi h
he esea ch me hod yielded a o al o 772 s udies a -
e he emo al o duplica e s udies. A e e iewing
he i les and abs ac s, a o al o 53 s udies we e ob-
ained, which we e hen assessed by wo e iewe s
o de e mine which s udies would be included in his
e iew. A e e iewing he ull pape s, 9 s udies we e
included in his e iew [17-25]. All s udies included in
his esea ch we e assessed o isk o bias using JBI,
whe e eigh o he nine s udies had a low isk o bias
and one s udy had a mode a e isk o bias (Table 2).
Fig. 1. Diag am o sys ema ic sea ch p ocess based on PRISMA
l ow 2020
F. Fa abi, M. N.A i a, P. Puspawikan, B. B. Tiksnadi
102
Table 2. Baseline cha ac e is ic o he s udy included in his e iew
S udy ID S udy
popula ion
S udy
Me hod
Albumin
pa ame e
Good co ona y colla e al ci cula ion Poo co ona y colla e al ci cula ion
Sample size Age Sex (Male) BMI Sample size Age Sex (Male) BMI
Dong e al.
2024
1093
pa ien s CAD
and CTO
C oss-
sec ional
Glyca ed
albumin 775 59.1 ± 10.2 666 (85.9%) 26.23 ± 3.32 318 58.0 ± 10.1 270 (84.9%) 26.70 ± 3.21
Zhao e al.
2020
391 pa ien s
S able CAD
C oss-
sec ional Albumin 298 60.83 ± 11.77 230 (77.2) - 93 63.06 ± 9.56 79 (84.9) -
Shen e al.
2013
434 pa ien s
CAD and
CTO
C oss-
sec ional
Glyca ed
albumin
95 (non-
diabe es)
and 199
(diabe es)
62.4 ± 10.4
(non-diabe es)
and 64.6 ± 11.1
(diabe es)
83 (87.4%) in
non-diabe es and
172 (84.6%) in
diabe es
24.8 ± 3.0
(non-diabe es)
and 25.1 ± 3.4
(diabe es)
22 (non-
diabe es)
and 118
(diabe es)
68 ± 11.1 (non-
diabe es) and
66.5 ± 10.1
(diabe es)
10 (45.5%) in
non-diabe es
and 77
(65.3%) in
diabe es
25.3 ± 2.8
(non-diabe es)
and 25.8 ± 3.4
(non-diabe es)
Top ak e al.
2023
415 pa ien s
CAD and
CTO
C oss-
sec ional Albumin 232 57 ± 13 156 (67.2) 26.6 ± 4.0 183 57 ± 12 111 (60.7) 27.3 ± 4.3
Chen e al.
2020
128 pa ien s
CAD and
CTO
C oss-
sec ional
Ischemic
modi i ed
albumin
59 60.92 ± 11.61 45 (76.3) - 69 61.28 ± 11.61 45 (65.2) -
Gao e al.
2022
792 pa ien s
CAD and
CTO
C oss-
sec ional
Glyca ed
albumin 570 59.15 ± 10.40 493 (86.5%) 26.30 ± 3.33 222 58.51 ± 9.93 184 (82.9%) 26.62 ± 3.09
Liu e al. 2021
1653 CAD
inpa ien s
wi h CTO
Coho Glyca ed
albumin 1298 59.1 ± 10.3 1074 (82.7) 26.0 ± 3.1 355 57.7 ± 10.5 294 (82.8) 28.1 ± 3.7
Akbuga e al.
2022
172 CAD
pa ien s wi h
CTO
C oss-
sec ional Albumin 98 67.5 ± 10.2 80 (81.6) - 74 67.7 ± 10.7 53 (71.7) -
Şaylık e al.
2023
212 CAD
pa ien s wi h
CTO
C oss-
sec ional Albumin 120 59.5386 ±
14.2571 79 (65.8) 27.289 ±
3.3016 92 60.1761 ±
11.674 69 (75.0) 27.8 ± 2.862
103
U ic acid/albumin a io as a no el bioma ke o p edic ing...
Baseline Cha ac e is ics
The o al popula ion in hese s udies was 5290 sub-
jec s, including 3744 subjec s wi h good co ona y col-
la e al ci cula ion and 1546 subjec s wi h poo co ona y
ci cula ion. Fou o he nine s udies assessed albumin
pa ame e s using glyca ed albumin and one s udy as-
sessed albumin pa ame e s using ischemic modi i ed
albumin (Table 3).
P ima y Ou come: U ic Acid o Albumin
Ra io and Co ona y Colla e al Ci cula ion
Fo ma ion
The u ic acid/albumin a io is co ela ed wi h CCC
o ma ion, wi h he lowe he UAR, he mo e likely CCC
o ma ion will occu (SMD -0.31, 95% CI -0.56 o -0.05,
p- alue 0.02, I2 93%). Subanalysis o UAR in he wo
g oups o albumin and glyca ed albumin examina ion
showed simila esul s, showing ha lowe UAR was
Table 3. Risk o bias assessed by he Joanna B iggs Ins i u e (JBI) C i ical App aisal Tools o use in JBI C i ical
App aisal Checklis o Analy ical C oss-Sec ional S udies
Au ho s Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 % Yes Risk
Shen e al. 2013
100% Low
Zhao e al. 2020 ---
62.5% Mode a e
Chen e al. 2020 --
75% Low
Liu e al. 2021 - -75% Low
Akbuga e al. 2022 --
75% Low
Gao e al. 2022 --
75% Low
Top ak e al. 2023 --
75% Low
Şaylık e al. 2023 --
75% Low
Dong e . Al. 2024
100% Low
Q1. We e he c i e ia o inclusion in he sample clea ly de i ned? Q2. We e he s udy subjec s and he se ing desc ibed in de ail? Q3. Was
he exposu e measu ed in a alid and eliable way? Q4. We e objec i e, s anda d c i e ia used o measu emen o he condi ion? Q5. We e
con ounding ac o s iden i i ed? Q6. We e s a egies o deal wi h con ounding ac o s s a ed? Q7. We e he ou comes measu ed in a alid and
eliable way? Q8. Was app op ia e s a is ical analysis used? : Yes; -: No.
Fig. 2. Fo es plo me a-analysis on he associa ion be ween u ic acid o albumin a io and co ona y colla e al ci cula ion o ma ion
Fig. 3. Subanalysis o UAR based on albumin and glyca ed albumin examina ion pa ame e s
F. Fa abi, M. N.A i a, P. Puspawikan, B. B. Tiksnadi
104
mo e likely o esul in CCC o ma ion, bu bo h g oups
we e no s a is ically signi i can .
Seconda y Ou come: U ic Acid and Albumin
Le els o Co ona y Colla e al Ci cula ion
Fo ma ion
In he analysis o he diff e en pa ame e s, u ic acid
is also co ela ed wi h CCC o ma ion (SMD -0.41, 95%
CI -0.74 o -0.08, p- alue 0.01, I2 96%), while albumin
has no s ong co ela ion. Howe e , when subanalysis
is pe o med based on albumin and glyca ed albumin
pa ame e s, bo h a e co ela ed wi h CCC o ma ion,
bu wi h opposi e esul s. The e we e ou s udies o
each pa ame e . Highe albumin inc eased he likeli-
hood o CCC (SMD 0.22, 95% CI 0.10 o 0.34, p- alue
0.0004, I2 0%), while lowe glyca ed albumin inc eased
he likelihood o CCC (SMD -0.24, 95% CI -0.35 o
-0.14, p- alue <0.001, I2 48%).
Fig. 4. Fo es plo me a-analysis on he associa ion be ween u ic acid and co ona y colla e al ci cula ion o ma ion
Fig. 5. Fo es plo me a-analysis on he associa ion be ween albumin and co ona y colla e al ci cula ion o ma ion
Fig. 6. Subanalysis based on albumin and glyca ed albumin examina ion pa ame e s
105
U ic acid/albumin a io as a no el bioma ke o p edic ing...
He e ogenei y and Publica ion Bias
The e was high he e ogenei y in he p ima y and
seconda y ou come analysis, bu he he e ogenei y
was no signi i can in he subanalysis based on albu-
min measu emen ype. The albumin pa ame e s in l u-
enced he he e ogenei y sco e o he s udy. The unnel
plo analysis showed a symme ic pic u e, and he e-
sul s o he Egge ’s es analysis showed a p- alue o
0.69, indica ing ha he e was no signi i can publica ion
bias in his s udy.
Sensi i i y Analysis
Sensi i i y analysis was pe o med by elimina ing s ud-
ies based on he ype o albumin assayed and also by elim-
ina ing each s udy o see how each s udy aff ec ed he e-
sul s. The esul s o he sensi i i y analysis o he exclusion
s udies based on he ype o albumin examined showed
esul s ha emained consis en bu we e no s a is ically
signi i can (Fig. 8, 9). This indica es ha i is s ill less obus .
Howe e , he esul s o he sensi i i y analysis by excluding
each s udy showed consis en esul s (Table 4).
Fig. 8. Sensi i i y anal-
ysis by exclusion o
glyca ed albumin pa-
ame e s
Fig. 9. Sensi i i y anal-
ysis by exclusion o al-
bumin pa ame e s
Table 4. Sensi i i y analysis
SMD (95% CI) I2
Omi ing Shen e al. 2013 -0.30 (-0.58 - -0.01) 94%
Omi ing Zhao e al. 2020 -0.36 (-0.63 - -0.09) 94%
Omi ing Chen e al. 2020 -0.31 (-0.58 - -0.04) 94%
Omi ing Liu e al. 2021 -0.36 (-0.64 - -0.08) 93%
Omi ing Gao e al. 2021 -0.35 (-0.64 - -0.06) 94%
Omi ing Akbuga e al. 2022 -0.27 (-0.54 - -0.01) 94%
Omi ing Saylik e al. 2023 -0.16 (-0.33 - 0.01) 84%
Omi ing Top ak e al. 2023 -0.31 (-0.59 - -0.03) 94%
Omi ing Dong e al. 2024 -0.34 (-0.64 - -0.03) 94%
Fig. 7. Funnel plo o publica ion bias
F. Fa abi, M. N.A i a, P. Puspawikan, B. B. Tiksnadi
106
D
Co ona y a e y disease (CAD) emains a majo
global heal h p oblem. The high mo bidi y and mo -
ali y a es o his disease equi e simple sc eening
pa ame e s o assess u u e p ognosis. One o he
new pa ame e s ha can assess he p ognosis is
UAR. U ic acid plays a ole in he in l amma o y p o-
cess in he ca dio ascula sys em, while albumin has
he opposi e ole as an an i-in l amma o y and an iox-
idan . U ic acid can inc ease in l amma o y esponses
h ough he ac i a ion p ocess o nucleo ide-binding
oligome iza ion domain-like ecep o s (NLRs) [26,
27]. A s udy by Ruge io e al. showed an associa ion
be ween u ic acid le els and inc eased ma ke s o
in l amma ion [28]. In l amma o y condi ions a e close-
ly ela ed o he incidence o ca dio ascula disease
and may ep esen one o he pa ame e s ha p edic
wo se ou comes [29, 30]. Hype u icemia may be con-
side ed a isk ac o o hea ailu e and a pa ame-
e in he p ognosis o highe ca dio ascula mo ali y
[31, 32].
In l amma ion also plays a ole in he pa hophysiol-
ogy o CAD [33]. In l amma o y condi ions a e closely
ela ed o he p ocess o co ona y colla e al o ma ion
(CCC) in pa ien s wi h CAD. Se e al s udies ha e e-
po ed ha CCC o ma ion is co ela ed wi h se e -
al in l amma o y pa ame e s [34, 35, 36]. In CAD pa-
ien s, good CCC has he unc ion o educing in a c
a ea o p ese e myoca dial unc ion [37, 38]. People
wi h poo e co ona y colla e als also ha e a highe
endency o de elop acu e co ona y occlusion [39].
The e o e, CAD pa ien s wi h good CCC o ma ion
ha e a be e p ognosis.
This me a-analysis s udy showed ha pa ien s
wi h good CCC had lowe UAR alues. The s udy
by Top ak e al. showed simila esul s o his s udy
wi h an AUC alue o 0.733, 95% CI 0.685 o 0.781,
p- alue < 0.01, and when compa ed wi h o he in-
l amma o y pa ame e s such as C- eac i e p o ein o
albumin a io (CAR), neu ophil o lymphocy e a io
(NLR), pla ele o lymphocy e a io (PLR), sys emic
immune-in l amma ion index (SSI), and monocy e o
high-densi y lipop o ein choles e ol a io (MHR), UAR
was supe io o all o hem. UAR was also supe io o
bo h u ic acid and albumin [24]. In he popula ion o
CAD pa ien s wi h CTO, UAR can also be used as a
pa ame e o de ec CCC o ma ion [22]. In he se ing
o non-ST ele a ion myoca dial in a c ion (NSTEMI)
cases, UAR also has he abili y o p edic CCC con-
di ions and is supe io when compa ed o u ic acid o
albumin sepa a ely and C- eac i e p o ein (CRP) [40].
In addi ion o i s associa ion wi h CCC, UAR is
also a pa ame e o de e mining he se e i y o CAD
and NSTEMI [12, 41]. In pa ien s who ha e unde -
gone pe cu aneous co ona y in e en ion (PCI), UAR
may p edic long- e m mo ali y and in-s en es eno-
sis [42, 43]. In he se ing o ST ele a ion myoca dial
in a c ion (STEMI), UAR has a ole in p edic ing he
incidence o no- e l ow and new-onse a ial i b illa-
ion [44, 45]. The ole o UAR as a no el pa ame e
in co ona y a e y disease and myoca dial in a c ion
needs o be u he explo ed wi h a la ge sample
size, conside ing i s ole as a no el in l amma o y
ma ke has been pe o med e y well in se e al p e-
ious s udies.
This me a-analysis s udy could no show he cu -off
alue o UAR in p edic ing co ona y colla e al e en s.
This is because he included albumin pa ame e s had
diff e en ypes o es ing me hods. Howe e , he s udy
by Saylik e al. showed a cu -off alue o 1.32 o de ec
poo CCC wi h a sensi i i y o 72% and a speci i ci y o
83%. Ano he s udy by Top ak e al. also showed a no
oo diff e en cu -off poin o 1.62 wi h a sensi i i y o
70% and a speci i ci y o 71% [22, 24].
This s udy did no e alua e he ela ionship be-
ween poo colla e als and occu ence o ACS, so pa-
ien s wi h good colla e als may s ill de elop ACS, bu
pa ien s wi h good colla e als end o ha e a highe
su i al a e.
C
UAR could be a new pa ame e in p edic ing he
o ma ion o CCC in pa ien s wi h s able co ona y a -
e y disease, wi h lowe UAR alues indica i e o good
CCC o ma ion.
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