# Association of serum uric acid to high-density lipoprotein cholesterol ratio with all-cause mortality and cardiovascular disease mortality in patients with gout

## TL;DR

This study finds that a blood marker called UHR is linked to higher death risk in gout patients, suggesting it could help predict mortality.

## Contribution

The study introduces UHR as a novel prognostic biomarker for mortality risk in gout patients.

## Key findings

- Higher UHR is associated with increased all-cause and cardiovascular mortality in gout patients.
- A U-shaped relationship exists between UHR and all-cause mortality above a threshold of 21.6%.
- The associations between UHR and mortality are consistent across age, BMI, and sex subgroups.

## Abstract

The uric acid to high-density lipoprotein cholesterol ratio (UHR), a novel biomarker, has clinical value in diagnosing and evaluating metabolic syndrome, diabetes mellitus, and atherosclerosis. However, the relationship between UHR and mortality in gout patients is unknown.This study aimed to investigate UHR’s link to all-cause and cardiovascular mortality in gout patients.

Based on NHANES data from 2007 to 2018, 1,479 gout patients who completed follow-up as of December 31, 2018 were included, and patients were divided into four groups using UHR, we analyzed the relationship between UHR and risk of death using Cox regression models, tested for nonlinear relationships with a restricted cubic spline, and assessed for population heterogeneity by stratifying by sex, age, and body mass index.

The Kaplan-Meier analysis revealed that patients in the third UHR quartile (Q3) had the highest risk of death. The multivariate Cox regression analysis further confirmed that the overall mortality risk (HR: 1.44, 95% CI: 1.05–1.97) and cardiovascular mortality risk (HR: 1.73, 95% CI: 1.04–2.87) of this group were higher than those of the other groups. Restricted cubic spline analysis revealed a U-shaped association between UHR and all-cause mortality, with a significant positive correlation above a threshold of 21.6% (HR: 1.68, 95% CI: 1.26–2.24) and a linear positive correlation with cardiovascular mortality (HR: 1.40, 95% CI: 1.05–1.86). Subgroup analyses showed that these associations were consistent across age, BMI, and sex (p > 0.05 for interaction).

This study confirms that UHR in gout patients has a U-shaped correlation with all-cause mortality and a linear correlation with cardiovascular mortality. Therefore, UHR may serve as a novel prognostic biomarker for mortality risk stratification in patients with gout.

The online version contains supplementary material available at 10.1186/s12872-025-05254-x.