Association Between Serum Uric Acid and Pulmonary Hypertension in Takayasu Arteritis With Pulmonary Artery Involvement: A Cross-Sectional Study.

Abstract

Pulmonary hypertension (PH) is a severe complication of Takayasu arteritis (TAK) with pulmonary artery involvement (PAI), associated with poor prognosis. Serum uric acid (UA) has been linked to both TAK severity and PH in other settings, but its role specifically in TAK-PAI-associated PH remains unclear. This study aimed to investigate the relationship between serum UA and the presence and severity of PH in TAK patients with confirmed PAI. This cross-sectional study enrolled 90 consecutive TAK patients with PAI documented by CT pulmonary angiography. All patients underwent echocardiography; those with echocardiographic signs of PH underwent confirmatory right heart catheterization (RHC). PH was defined as mean pulmonary artery pressure > 20 mmHg with pulmonary artery wedge pressure ≤ 15 mmHg (2022 ESC/ERS criteria). Serum UA was measured at baseline. Multivariable logistic regression, subgroup analyses, and restricted cubic spline (RCS) were performed. Among 90 patients, 42 (46.7%) met the PH criteria. Patients with PH had significantly higher serum UA levels than those without PH (400.5 ± 140.8 vs. 305.2 ± 91.6 μmol/L, p < 0.001). After adjusting for age, sex, eGFR, and Kerr score (disease activity), each 10 μmol/L increase in UA was associated with a 10% higher odds of PH risk (OR = 1.10, 95% CI 1.04-1.16, p = 0.001). Compared with the lowest tertile (< 284 μmol/L), the highest tertile (≥ 377 μmol/L) had an 8-fold increased odds of PH risk (OR = 8.03, 95% CI 2.03-31.79, p = 0.003). Subgroup analyses showed consistent associations across sex, disease activity, and PAI pattern. RCS analysis revealed no significant nonlinearity (p = 0.729), indicating a predominantly linear dose-response relationship. Elevated serum uric acid is independently associated with higher odds of PH in TAK patients with PAI, exhibiting a linear dose-response pattern. A uric acid level ≥ 377 μmol/L may identify patients at substantially increased odds of PH. Serum UA could serve as a simple, noninvasive biomarker for PH risk stratification in this high-risk population. Trial Registration: ClinicalTrials.gov: NCT07184814.