Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, Guangdong, China.
Department of Health Management Center, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, Guangdong, China.
BMC Endocr Disord. 2021 May 8;21(1):97. doi: 10.1186/s12902-021-00745-2.
Hyperuricemia has attracted increasing attention. However, limited concern has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in patients with COVID-19. Therefore, we aim to explore whether patients with COVID-19 had SUA lower than normal and the relationship of SUA and the severity of COVID-19.
This was a case-control study based on 91 cases with COVID-19 and 273 age- and sex-matched healthy control subjects. We first compared SUA levels and uric acid/creatinine (UA/Cr) ratio between patients with COVID-19 and the healthy controls. Then, we examined the association of SUA levels and UA/Cr ratios with COVID-19 severity in COVID-19 cases only, defined according to the fifth edition of China's Diagnosis and Treatment Guidelines of COVID-19.
SUA levels in patients with COVID-19 were 2.59% lower, UA/Cr ratios 6.06% lower at admission compared with healthy controls. In sex stratified analysis, levels of SUA and UA/Cr were lower in male patients with COVID-19 while only level of SUA was lower in female patients with COVID-19. Moreover, SUA and UA/Cr values were 4.27 and 8.23% lower in the severe group than that in the moderate group among male COVID-19 patients. Bivariate and partial correlations analysis showed negative correlations between SUA or UA/Cr ratio and COVID-19 after adjusting for age, sex, BMI and eGFR. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent risk factors associated with lower SUA levels. Male patients with COVID-19 accompanied by low SUA levels had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11, 14.72) at admission. Comparing SUA and UA/Cr ratio at three time points (admission, discharge, and follow-up), we found that male patients experienced severe symptoms had lower SUA and UA/Cr ratio levels comparing to moderate patients, but no significant difference between three time points. On the contrary, female patients had lower SUA and UA/Cr ratio at discharge than those at admission, but no significant difference of SUA and UA/Cr ratio between moderate and severe group.
Patients with COVID-19 had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher crude risk of developing severe symptoms than those with high SUA levels. During disease aggravation, the level of SUA gradually decreased until discharge. At the follow-up exam, the level of SUA was similar to the levels at admission.
高尿酸血症已引起越来越多的关注。然而，人们对降低血清尿酸（SUA）的潜在危险关注甚少。我们观察到 COVID-19 患者的 SUA 水平较低。因此，我们旨在探讨 COVID-19 患者的 SUA 是否低于正常水平，以及 SUA 与 COVID-19 严重程度的关系。
这是一项基于 91 例 COVID-19 患者和 273 名年龄和性别匹配的健康对照者的病例对照研究。我们首先比较了 COVID-19 患者和健康对照者的 SUA 水平和尿酸/肌酐（UA/Cr）比值。然后，我们仅在 COVID-19 患者中检查了 SUA 水平和 UA/Cr 比值与 COVID-19 严重程度的关联，根据《中国 COVID-19 诊断与治疗指南》（第五版）进行定义。
COVID-19 患者入院时的 SUA 水平降低了 2.59%，UA/Cr 比值降低了 6.06%。在性别分层分析中，男性 COVID-19 患者的 SUA 和 UA/Cr 水平均降低，而女性 COVID-19 患者仅 SUA 水平降低。此外，在男性 COVID-19 患者中，重度组的 SUA 和 UA/Cr 值分别比中度组低 4.27%和 8.23%。双变量和偏相关分析显示，在调整年龄、性别、BMI 和 eGFR 后，SUA 或 UA/Cr 比值与 COVID-19 呈负相关。多元线性回归分析表明，SARS-CoV-2 感染和男性是与较低 SUA 水平相关的独立危险因素。COVID-19 男性患者入院时伴有低 SUA 水平，其发生严重症状的风险高于高 SUA 水平患者（发生率比：4.05；95%CI：1.11，14.72）。比较 SUA 和 UA/Cr 比值在三个时间点（入院、出院和随访）的变化，我们发现，发生严重症状的男性 COVID-19 患者的 SUA 和 UA/Cr 比值水平低于中度症状患者，但三个时间点之间没有显著差异。相反，女性 COVID-19 患者出院时的 SUA 和 UA/Cr 比值低于入院时，但中度症状和重度症状患者之间的 SUA 和 UA/Cr 比值没有显著差异。
COVID-19 患者入院时的 SUA 和 UA/Cr 值低于正常水平。与高 SUA 水平患者相比，男性 COVID-19 患者的低 SUA 水平有显著更高的发生严重症状的风险。在疾病加重期间，SUA 水平逐渐下降直至出院。在随访检查中，SUA 水平与入院时相似。
