Serum Uric Acid Concentrations and Risk of Adverse Outcomes in Patients With COVID-19

Abstract

BackgroundAlthough hyperuricemia frequently associates with respiratory diseases, patients with severe coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) can show marked hypouricemia. Previous studies on the association of serum uric acid with risk of adverse outcomes related to COVID-19 have produced contradictory results. The precise relationship between admission serum uric acid and adverse outcomes in hospitalized patients is unknown.MethodsData of patients affected by laboratory-confirmed COVID-19 and admitted to Leishenshan Hospital were retrospectively analyzed. The primary outcome was composite and comprised events, such as intensive care unit (ICU) admission, mechanical ventilation, or mortality. Logistic regression analysis was performed to explore the association between serum concentrations of uric acid and the composite outcome, as well as each of its components. To determine the association between serum uric acid and in-hospital adverse outcomes, serum uric acid was also categorized by restricted cubic spline, and the 95% confidence interval (CI) was used to estimate odds ratios (OR).ResultsThe study cohort included 1854 patients (mean age, 58 years; 52% women). The overall mean ± SD of serum levels of uric acid was 308 ± 96 µmol/L. Among them, 95 patients were admitted to ICU, 75 patients received mechanical ventilation, and 38 died. In total, 114 patients reached composite end-points (have either ICU admission, mechanical ventilation or death) during hospitalization. Compared with a reference group with estimated baseline serum uric acid of 279-422 µmol/L, serum uric acid values ≥ 423 µmol/L were associated with an increased risk of composite outcome (OR, 2.60; 95% CI, 1.07- 6.29) and mechanical ventilation (OR, 3.01; 95% CI, 1.06- 8.51). Serum uric acid ≤ 278 µmol/L was associated with an increased risk of the composite outcome (OR, 2.07; 95% CI, 1.18- 3.65), ICU admission (OR, 2.18; 95% CI, 1.17- 4.05]), and mechanical ventilation (OR, 2.13; 95% CI, 1.06- 4.28), as assessed by multivariate analysis.ConclusionsThis study shows that the association between admission serum uric acid and composite outcome of COVID-19 patients was U-shaped. In particular, we found that compared with baseline serum uric acid levels of 279-422 µmol/L, values ≥ 423 µmol/L were associated with an increased risk of composite outcome and mechanical ventilation, whereas levels ≤ 278 µmol/L associated with increased risk of composite outcome, ICU admission and mechanical ventilation.

Impact of interferon-induced transmembrane protein 3 gene rs12252 polymorphism on COVID-19 mortality

“…The uric acid concentration in the dead cases was substantially lower than in the recovered individuals. This result was in agreement with several reports [26] , [27] . Uric acid is a natural byproduct of purine catabolism that plays a variety of intricate and changeable roles in the body and is more than just a metabolic byproduct.…”

Old Age is an Independent Risk Factor for Pneumonia Development in Patients with SARS-CoV-2 Omicron Variant Infection and a History of Inactivated Vaccine Injection

“…[19][20][21][22] Patients with lower uric acid levels were more likely to have severe symptoms. 23,24 It was speculated that the cellular and humoral immunity was impaired and the level of neutralizing antibodies reduced with age. Thus, it was anticipated that the regulation of metabolism and immunity might be a promising intervention in treating COVID-19.…”

U-Shaped Association Between Serum Uric Acid and Short-Term Mortality in Patients With Infective Endocarditis

“…A recent study conducted by Chen et al. included 1,854 patients with COVID-19 infection and showed a U-shaped association between UA and composite outcomes ( 28 ). Their cut-off values were ≥423 µmol/L and ≤278 µmol/L, which was close to our findings.…”