Hyperuricemia and Adverse Outcomes in Patients Hospitalized for COVID-19 Disease

Abstract

Background: Hyperuricemia is associated with several risk factors for mortality and severe coronavirus disease 2019 (COVID-19) manifestations. Objective:The objective of this research was to examine whether hyperuricemia is a risk factor for mortality and other adverse outcomes in patients hospitalized for COVID-19.Design: This is a retrospective review of patients hospitalized for COVID-19 between March 15 and November 30, 2020, with available uric acid (UA) levels.Results: Among 1566 patients who were hospitalized during the study period, 222 patients had an available UA level. The mean age ± standard deviation (SD) was 56.5 ± 19.5 years. The mean ± SD for UA (mg/dL) among the total cohort was 5.65 ± 2.18, and 21.2% of the total study population had hyperuricemia (UA > 7 mg/dL) on admission. The mortality rate was 14.4%, and mortality was associated with higher UA levels on admission (6.9 ± 2.6 mg/dL vs. 5.5 ± 2 mg/dL in patients who survived, P < 0.05). Patients who needed intensive oxygen support (high-flow nasal cannula or mechanical ventilation) and those who required longer-than-average hospitalization (> 7 days) had more hyperuricemia (intensive oxygen support: 30% vs. 18%, P = 0.07; long hospitalization 29% vs. 16.2%, P < 0.05). Conclusion:Our findings show that high UA levels are associated with adverse outcomes in patients hospitalized for COVID-19. We suggest evaluating hyperuricemia as a marker that integrates and reflects both poor prognostic baseline characteristics and acute components such as inflammatory state, hypovolemic state, and renal failure.

Clinical Characteristics and Fatality Risk Factors for Patients with Listeria monocytogenes Infection: A 12-Year Hospital-Based Study in Xi’an, China

“…Previous reports revealed that hyperuricemia was associated with increased risk of 90-day all-cause mortality and the incidence of acute kidney injury in patients with sepsis [ 48 ]. High uric acid levels were also associated with adverse outcomes in patients hospitalized for coronavirus disease 2019 [ 49 ]. Thus, we suggested that evaluating hyperuricemia as a potential marker might reflect poor prognostic baseline characteristics in non-neonatal listeriosis.…”

Exploring the Relationship of SARS-CoV-2 and Uric Acid Levels With a Focus on Gout Patients: A Scoping Review

“…Upon discharge, it was noted males had low serum uric acid levels as well as low UA/Cr levels [ 19 ]. On admission, low serum uric acid and low UA/Cr were found to lead to worsened SARS-CoV-2 outcomes and subsequently increased mortality [ 4 , 19 ].…”

“…There are many comorbidities associated with gout, such as increased rates of mortality when infected with SARS-CoV-2. It was concluded that women with gout had lower rates of severe SARS-CoV-2 infection due to an increased immune response from higher levels of CD4 T cells in comparison to men [ 4 , 14 , 15 , 19 ]. It can be concluded that the higher levels of testosterone in males upregulates URAT1, increasing reabsorption of uric acid and therefore increasing uric acid levels [ 19 ].…”

“…It is important to note some of the limitations of included articles. Small sample sizes were noted in six studies, as can be seen in Table 1 , which may restrict the generalizability of the findings [ 4 , 7 , 12 , 19 , 22 , 23 ]. One study by Feldman et al was unable to obtain uric acid levels in 80% of patients with COVID-19 infection.…”

“…The condition has been shown to increase the incidence of diseases outside the musculoskeletal system, including the renal and cardiovascular systems. Comorbid conditions associated with gout include, but not limited to type 2 diabetes mellitus (T2DM), hypertension, hyperlipidemia, chronic kidney disease, cardiovascular disease, and heart failure [ 3 , 4 ]. The increase in uric acid levels and chronic inflammatory state tied to gout has been shown to play a role in viral infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.…”