Establishment of gender- and age-related reference intervals for serum uric acid in adults based on big data from Zhejiang Province in China.

Abstract

Objectives: This study utilized large-scale health examination data to explore gender- and age-specific reference intervals (RIs) for serum uric acid (UA) using indirect methods and assessed the consistency of different approaches.

Methods: UA data were collected from a hospital in Zhejiang Province, China. The test set covered January 2019 to December 2023, with a validation set from January to June 2024. Various methods - EP28 nonparametric (EP28-NP), parametric (EP28-P), TMC, refineR, and Kosmic - were used to establish gender- and age-specific RIs. Continuous age-based RIs were derived using the Generalized Additive Model for Location Scale and Shape (GAMLSS). Validation rates were calculated for each method using the validation set.

Results: Using EP28-NP as the benchmark, other methods showed similar UA RIs (bias ratios ≤0.375, except for one group), with Kosmic, refineR, and TMC yielding slightly higher values than EP28-NP and EP28-P. For males, UA RIs varied by age: 19-42 years (256-537 μmol/L), 43-66 years (235-513 μmol/L) and ≥67 years (214-515 μmol/L), with validation rates ranging from 94.05 to 96.50 %. Male continuous RIs declined from ages 20-79 and then gradually increased after age 80. For females, UA RIs were age-dependent: 19-48 years (169-374 μmol/L), 49-74 years (178-405 μmol/L), and ≥75 years (186-470 μmol/L), with validation rates ranging from 92.70 to 96.80 %. Female continuous RIs decreased from ages 20-48, then increased significantly from age 49 onward.

Conclusions: Three indirect methods and two EP28 methods demonstrated good consistency in establishing UA RIs. Males had higher RIs than females, and RIs showed a non-linear correlation with age.