Serum Uric Acid Concentrations and Risk of Adverse Outcomes in Patients With COVID-19.
Level 3 - non-randomized controlled study
Retrospective cohort study
PubMed 34025575 · doi:10.3389/fendo.2021.633767
What was done
Data from 1,854 laboratory-confirmed COVID-19 patients admitted to Leishenshan Hospital were retrospectively analyzed. The primary outcome was a composite of intensive care unit (ICU) admission, mechanical ventilation, or in-hospital death. Logistic regression and restricted cubic splines were used to evaluate the association between admission serum uric acid levels and clinical outcomes in multivariate models.
What was found
Among 1,854 patients (mean age 58 years; 52% women; mean serum uric acid 308 ± 96 µmol/L), 114 reached the composite endpoint (95 ICU admissions, 75 mechanical ventilations, 38 deaths). Compared to reference baseline levels (279 to 422 µmol/L), uric acid ≥423 µmol/L was associated with increased risk of the composite outcome (OR 2.60, 95% CI 1.07 to 6.29) and mechanical ventilation (OR 3.01, 95% CI 1.06 to 8.51). Uric acid ≤278 µmol/L was associated with increased risk of the composite outcome (OR 2.07, 95% CI 1.18 to 3.65), ICU admission (OR 2.18, 95% CI 1.17 to 4.05), and mechanical ventilation (OR 2.13, 95% CI 1.06 to 4.28).
Why it matters
This study demonstrates a U-shaped relationship between admission uric acid and COVID-19 severity, reconciling contradictory reports by showing that both hypouricemia and hyperuricemia are associated with adverse outcomes.
Limits
The retrospective single-center design prevents causal conclusions. Serum uric acid was measured only at admission, leaving longitudinal changes unassessed. The abstract reports no data on confounding factors such as underlying kidney disease, diuretic therapy, or uric acid-lowering medications.
Cited by
- supports Hospitalized COVID-19 patients with elevated baseline uric acid have a twofold to threefold increased risk of ICU admission, mechanical ventilation, or death.