Prevalence and Outcomes Associated with Hyperuricemia in Hospitalized Patients with COVID-19

Abstract

<b><i>Introduction:</i></b> Coronavirus 2019 (COVID-19) can increase catabolism and result in hyperuricemia. Uric acid (UA) potentially causes kidney damage by alteration of renal autoregulation, inhibition of endothelial cell proliferation, cell apoptosis, activation of the pro-inflammatory cascade, and crystal deposition. Hyperuricemia in patients with COVID-19 may contribute to acute kidney injury (AKI) and poor outcomes. <b><i>Methods:</i></b> We included 834 patients with COVID-19 who were >18 years old and hospitalized for >24 h in the Mount Sinai Health System and had at least 1 measurement of serum UA. We examined the association between the first serum UA level and development of acute kidney injury (AKI, defined by KDIGO criteria), major adverse kidney events (MAKE, defined by a composite of all-cause in-hospital mortality or dialysis or 100% increase in serum creatinine from baseline), as well as markers of inflammation and cardiac injury. <b><i>Results:</i></b> Among the 834 patients, the median age was 66 years, 42% were women, and the median first serum UA was 5.9 mg/dL (interquartile range 4.5–8.8). Overall, 60% experienced AKI, 52% experienced MAKE, and 32% died during hospitalization. After adjusting for demographics, comorbidities, and laboratory values, a doubling in serum UA was associated with increased AKI (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.9–4.1), MAKE (OR 2.5, 95% CI 1.7–3.5), and in-hospital mortality (OR 1.7, 95% CI 1.3–2.3). Higher serum UA levels were independently associated with a higher level of procalcitonin (β, 0.6; SE 0.2) and troponin I (β, 1.2; SE 0.2) but were not associated with serum ferritin, C-reactive protein, and interleukin-6. <b><i>Conclusion:</i></b> In patients admitted to the hospital for COVID-19, higher serum UA levels were independently associated with AKI, MAKE, and in-hospital mortality in a dose-dependent manner. In addition, hyperuricemia was associated with higher procalcitonin and troponin I levels.

Redox imbalance in COVID-19 pathophysiology

“…Interestingly, contradictory reports about the uric acid levels in the COVID-19 subjects are reported. On one hand, increased uric acid levels were associated with adverse outcomes in children hospitalized with severe COVID-19 and hyperuricemia was associated with acute kidney injury and in hospital mortality [ [72] , [73] , [74] ]. Conversely, lower uric acid levels were proposed as prognostic marker for COVID-19 and were associated with disease severity [ 75 , 76 ].…”

Clinical clustering with prognostic implications in Japanese COVID-19 patients: report from Japan COVID-19 Task Force, a nation-wide consortium to investigate COVID-19 host genetics

“…Cluster 3 included mainly middle-aged patients with a high BMI, and a high rate of complications from lifestyle-related diseases, such as hypertension, diabetes, and hyperuricemia. Even though hyperuricemia has been previously reported to be associated with prognosis [ 38 , 39 ], its rate was higher in Cluster 3 than in Cluster 4, which showed the highest mortality rate. This finding may be due to a possible association between obesity and hyperuricemia [ 40 , 41 ].…”

Factors Contributing to Chronic Kidney Disease following COVID-19 Diagnosis in Pre-Vaccinated Hospitalized Patients

“…In this study, hyperuricemia and antibiotic use contributed to CKD following COVID-19 diagnosis. Based on the study by Chauhan et al, uric acid (UA) was associated with increased AKI (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.9–4.1) and in-hospital mortality (OR 1.7, 95% CI 1.3–2.3) [ 50 ].…”