Pre-conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation

Abstract

Uric acid, a known danger signal released from injured cells, is one of the valuable signs of inflammation. We aimed to evaluate the association of serum uric acid level before the start of conditioning regimen with the risk of hepatic SOS development after HSCT. Two hundred and twenty-two children who underwent allogeneic HSCT at the Pediatric BMT Unit of Hacettepe University between 2000 and 2014 were included in this retrospective study. Serum UA levels were measured before conditioning as an indicator of the pre-transplant inflammatory status of patients. Patients with or without diagnosis of SOS were compared regarding primary diagnosis, previously described risk factors for SOS and pre-conditioning serum UA. SOS was diagnosed in forty-two patients who had higher pre-conditioning serum UA levels compared to those who did not. Pre-transplant serum creatinine, GGT, bilirubin, ferritin and CRP didn’t differ significantly among the patients with or without SOS except serum albumin which was lower in the patients who developed SOS. ROC analysis revealed that pre-conditioning UA level higher than 3,32 mg/dl was predictive of SOS. When subjected to a multivariate model, only pre-conditioning UA and albumin levels remained significant risk factors for SOS (UA; OR, 2.54; 95%CI,1.26 to 5,12; P=0,009 and albumin; OR, 0.45; uncorrected proof 95%CI,0.22 to 0.95; P= 0.037). Our results suggest that pre-conditioning serum UA is an independent risk factor for SOS, and it might be used as an early predictor of hepatic SOS together with previously described clinical/laboratory parameters.