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Hyperuricemia as a prognostic indicator in critically ill patients with sepsis: A prospective cohort study

. Dr.Ajay NageshBhat, Dr. Padma Priya , Dr. Alam Nawaz and Dr. M. VenkatrayaPrabhu


Abstract

Introduction: Uric acid activates proinflammatory markers and also has antioxidant property. Sepsis is a condition in which there is increased oxidative stress and lower antioxidant levels which results in dysfunction of multiple organs. In patients with sepsis uric acid could be utilized as an indicator of oxidative stress and worse prognosis.

Methods: Prospective data was collected for 18 months in the ICU of our hospital and theorized that in patients with sepsis elevated uric acid is a indicator of poor prognosis. The primary outcome was to examine the association between uric acid levels in patients presenting with sepsis and morbidities like Acute kidney injury (AKI), Acute respiratory distress syndrome (ARDS), duration of ICU stay and mortality. Supplementary end points were the need for renal replacement therapy and mechanical ventilation. Severity of illness was measured using the SOFA score.

Results: Overall 160 sepsis patients were enrolled. 68 (42.5%) patients had hyperuricemia. The overall morbidity rate was 80.3%. The possibility of having a uric acid value of <7mg/dL along with AKI is 13.1% and without AKI is 86.9%, Meanwhile the possibility of havinga uric acid value of >7mg/dL along with AKI is 73.5% and without AKI is 26.5% (???? value < 0.0001). Among patients with hyperuricemia and AKI, 42% required renal replacement therapy. Hyperuricemia was also associated with prolonged duration of ICU stay and higher SOFA scores.

Conclusions: In patients with sepsis elevated uric acid levels on admission to the ICU are associated with poor prognosis. Sepsis patients are at an enhanced risk for AKI, renal replacement therapy as well as prolonged duration of ICU stay.

Keywords: Hyperuricemia, Uric acid, Sepsis, Critical care, SOFA score, Acute kidney injury.

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