Objective This study aimed to investigate the dynamics of serum uric acid (sUA) during gastrointestinal cancer surgery. This study aimed to determine the correlation between postoperative hypouricemia and surgical complications. Methods This retrospective nested case-control study was conducted using data from 708 patients with gastrointestinal cancer (2018–2020) at a tertiary hospital. Postoperative complications were stratified using the Clavien-Dindo system. Through 1:1 propensity score matching (age ± 2 years, sex), 149 complication cases were matched to 149 controls. Serial sUA measurements were analyzed preoperatively (D0), within 24 h (D1), and 1–4 days postoperatively (D2). Hypouricemia was defined as sUA < 208 µmol/L (male) or < 155 µmol/L (female). Conditional logistic regression analyses were performed. Draw the Receiver Operating Characteristic (ROC) curve and calculate its Area Under Curve (AUC). Results The cohort (mean age 60.0 ± 10.5 years) demonstrated a 21.05% complication rate (15.54% severe). Case group exhibited significantly lower sUA levels at all timepoints (D0: 319.68 ± 79.21 vs. 343.59 ± 85.46 µmol/L, P = 0.009; D1: 212.25 ± 89.70 vs. 258.68 ± 88.72, P < 0.001; D2: 137.66 ± 70.59 vs. 188.73 ± 83.96, P < 0.001). The prevalence of hypouricemia was higher on D1 (68 vs. 26, χ²=27.413, P < 0.001) and D2 (135 vs. 83, χ²=46.204, P < 0.001). Adjusted analysis revealed that hypouricemia increased the risk of complications (D1: OR = 2.64, 95%CI 1.20–5.79; D2: OR = 11.31, 95%CI 3.75–34.13). ROC analysis showed that postoperative sUA had a predictive value [AUC(D1UA) = 0.659 (95%CI 0.597–0.721, P < 0.001) and AUC(D2UA) = 0.699 (95%CI 0.640–0.758, P < 0.001) ]. Conclusion Postoperative sUA decline correlates with the postoperative complication risk in gastrointestinal cancer surgery. Postoperative sUA level may have the ability to predict the occurrence of postoperative complications, suggesting that sUA monitoring could enhance postoperative surveillance strategies. However, further research is needed to confirm this association and evaluate its clinical utility.

The correlation between postoperative hypouricemia and postoperative complications in patients with gastrointestinal cancer: a retrospective nested case-control study

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2025年9月30日

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Kai Shi,
Hao-jie Xu,
Zheng-lun Lin,
Tian-jie Chen,
Hong-da Cai

摘要

Objective

This study aimed to investigate the dynamics of serum uric acid (sUA) during gastrointestinal cancer surgery. This study aimed to determine the correlation between postoperative hypouricemia and surgical complications.

Methods

This retrospective nested case-control study was conducted using data from 708 patients with gastrointestinal cancer (2018–2020) at a tertiary hospital. Postoperative complications were stratified using the Clavien-Dindo system. Through 1:1 propensity score matching (age ± 2 years, sex), 149 complication cases were matched to 149 controls. Serial sUA measurements were analyzed preoperatively (D₀), within 24 h (D₁), and 1–4 days postoperatively (D₂). Hypouricemia was defined as sUA < 208 µmol/L (male) or < 155 µmol/L (female). Conditional logistic regression analyses were performed. Draw the Receiver Operating Characteristic (ROC) curve and calculate its Area Under Curve (AUC).

Results

The cohort (mean age 60.0 ± 10.5 years) demonstrated a 21.05% complication rate (15.54% severe). Case group exhibited significantly lower sUA levels at all timepoints (D₀: 319.68 ± 79.21 vs. 343.59 ± 85.46 µmol/L, P = 0.009; D₁: 212.25 ± 89.70 vs. 258.68 ± 88.72, P < 0.001; D₂: 137.66 ± 70.59 vs. 188.73 ± 83.96, P < 0.001). The prevalence of hypouricemia was higher on D₁ (68 vs. 26, χ²=27.413, P < 0.001) and D₂ (135 vs. 83, χ²=46.204, P < 0.001). Adjusted analysis revealed that hypouricemia increased the risk of complications (D₁: OR = 2.64, 95%CI 1.20–5.79; D₂: OR = 11.31, 95%CI 3.75–34.13). ROC analysis showed that postoperative sUA had a predictive value [AUC(D₁UA) = 0.659 (95%CI 0.597–0.721, P < 0.001) and AUC(D₂UA) = 0.699 (95%CI 0.640–0.758, P < 0.001) ].

Conclusion

Postoperative sUA decline correlates with the postoperative complication risk in gastrointestinal cancer surgery. Postoperative sUA level may have the ability to predict the occurrence of postoperative complications, suggesting that sUA monitoring could enhance postoperative surveillance strategies. However, further research is needed to confirm this association and evaluate its clinical utility.