URIC ACID and COVID-19: PATTERN of CHANGES and ASSOCIATION with PROGNOSIS

ABSTRACT

Background: Coronavirus disease causes a proximal tubule dysfunction of kidneys, inducing uric acid loss [1]. It has been established that several changes in laboratory markers (C-reactive protein (CRP), ferritin, interleukin-6 (IL-6)) can predict the severity of Covid-19 [2]. The purpose of this retrospective study was to analyze whether uric acid could act as another predictor of severe Covid-19. Objectives: To evaluate the relationship between the severity of Covid-19 and uric acid levels on admission to the hospital. Methods: This retrospective study included 150 hospitalized patients with con-frmed Covid-19 (mean age 60.3±14.6 years;52% were men), the severity of which was determined by the presence and type of oxygen support (1) without O2, (2) O2 by mask or nasal cannula, (3) continuous positive airway pressure, (4) positive bi-pressure in the airways or high-fow oxygen, (5) invasive ventilation. Among them, 90 subjects required oxygen support, and 60 people didn't. The mortality rate in our study was 9.3%. The average uric acid level was compared with patients without Covid-19 (40 subjects). The study included patients who didn't receive urate-lowering therapy. Levels of CRP, ferritin, IL-6, D-dimer were also determined on admission. The Spearman's rank coefficient was used for measuring correlation. Results: The mean uric acid level in patients with coronavirus disease was 251.5±104.1 μ mol/L;without Covid-19 it was signifcantly higher - 328.6±96.9 μ mol/L (p<0.001). Approximately one in four (24.6%) Covid-19 patients had uric acid levels below the lower limit of normal (208 μ mol/L for men, 155 μ mol/L for women). A decrease in serum uric acid levels was also observed in patients suffering from asymptomatic hyperuricemia or gout. However, there was no correlation between uric acid levels and disease severity (r=0.01, p=0.88). Also, uric acid levels did not correlate with other laboratory markers of severe Covid-19 (CRP r=0.07, p=0.73;ferritin r=0.15, p=0,07;IL-6 r=0.11, p=0,22;D-dimer r=0.02, p=0,79). Conclusion: Low uric acid levels are common in patients with Covid-19, but are not predictive of a more severe course of this disease. A correlation between uric acid and the level of other laboratory markers of severe Covid-19 was not found.