Prevalence and Outcomes Associated with Hyperuricemia in Hospitalized Patients with COVID-19.
Level 3 - non-randomized controlled study
Retrospective observational cohort study evaluating prognostic associations
PubMed 34883482 · doi:10.1159/000520355
What was done
Researchers evaluated 834 adult patients hospitalized for over 24 hours with COVID-19 in the Mount Sinai Health System who had at least one serum uric acid (UA) measurement. They analyzed the association between the initial serum UA level and the risk of acute kidney injury (AKI, KDIGO criteria), major adverse kidney events (MAKE: composite of all-cause in-hospital mortality, new dialysis, or ≥100% creatinine increase), in-hospital mortality, and inflammatory/cardiac biomarkers, adjusting for demographics, comorbidities, and laboratory values.
What was found
Median patient age was 66 years, 42% were female, and median baseline serum UA was 5.9 mg/dL (IQR 4.5–8.8). Overall, 60% developed AKI, 52% developed MAKE, and 32% died. In multivariable models, a doubling of serum UA was significantly associated with AKI (OR 2.8, 95% 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 UA levels were independently associated with higher procalcitonin (β = 0.6, SE 0.2) and troponin I (β = 1.2, SE 0.2), but showed no significant association with ferritin, C-reactive protein, or IL-6.
Why it matters
Elevated serum uric acid is an independent, dose-dependent prognostic marker for severe renal outcomes and death in hospitalized COVID-19 patients, identifying high-risk individuals early during admission.
Limits
Selection bias is a major concern because serum uric acid is not routinely measured in all COVID-19 admissions and was only available in a subset of patients. As an observational study, it cannot establish whether hyperuricemia is causally damaging to kidneys or merely a marker of severe catabolism, hypoxia, and reduced renal clearance. Post-discharge kidney recovery and long-term mortality were not assessed.
Cited by
- supports Younger people with severe COVID-19 complications have a high frequency of obesity, and elevated uric acid may play a role in their increased risk.