HYPERURICEMIA AS AN EARLY MARKER IN PREDICTING MORBIDITY AND MORTALITY IN PATIENTS WITH SEPSIS

Abstract

Sepsis is a life-threatening condition characterized by a dysregulated immune response to infection, leading to
organ dysfunction. This study investigates the role of hyperuricemia as an early predictor of morbidity and mortality in sepsis patients. Conducted at Government Vellore Medical College & Hospital, this study analyzed
the relationship between elevated serum uric acid levels and sepsis outcomes, including acute kidney injury,
acute respiratory distress syndrome, and length of stay in the ICU. The findings suggest that hyperuricemia is a
significant prognostic marker for adverse outcomes in sepsis.
Aims To analyse hyperuricemia as an early marker in predicting the morbidity and mortality in patients with sepsis. To find out the correlation between hyperuricemia and severity of sepsis in clinically suspected sepsis patient
Introduction- Sepsis, a severe medical condition triggered by the body's extreme response to infection, can lead
to organ dysfunction and death if not promptly treated. The pathophysiology involves a complex interplay of
pro-inflammatory and anti-inflammatory responses, oxidative stress, and endothelial dysfunction. Recent studies
have highlighted the potential of serum uric acid as a prognostic marker for sepsis due to its role in oxidative stress and systemic inflammation.
Methods- This observational study included patients diagnosed with sepsis based on the quick Sequential Organ
Failure Assessment (qSOFA) score admitted to the ICU. Hyperuricemia was defined as serum uric acid levels >7 mg/dL. Data on patient demographics, clinical parameters, serum uric acid levels, and outcomes were collected and analyzed.
Results- The study conducted at the Department of General Medicine, MGM, aimed to investigate hyperuricemia as a potential early marker for predicting morbidity and mortality in sepsis patients. Out of the 200 patients studied, a significant majority (66%) were aged over 45 years, with a mean age of 66.2 years. The gender distribution was nearly equal. Common comorbidities observed included diabetes mellitus (30 patients), hypertension (29 patients), and cardiac diseases (24 patients). Clinical parameters revealed that patients typically
presented with an average respiratory rate of 25.4 per minute, mean arterial pressure of 65.9 mmHg, and systolic
blood pressure of 91.4 mmHg. Fever was prevalent (mean temperature 38.7°C), and neurological impairment, as
assessed by the Glasgow Coma Scale, indicated sepsis-related encephalopathy in 61.5% of cases. Laboratory
findings showed elevated inflammatory markers with a mean C-reactive protein level of 43.46 mg/dl and a mean
serum uric acid level of 7.44 mg/dl. Patients were stratified based on qSOFA scores, revealing 75 with sepsis,
47 with severe sepsis, and 78 in septic shock. Significant associations were found between serum uric acid
levels and qSOFA scores (p = 0.0021), as well as a strong positive correlation between qSOFA scores and uric
acid levels (r = 0.46, p = 0.001). Moreover, there was a notable difference in mean hospital stay durations across
sepsis severities, with septic shock patients staying an average of 21 days compared to 15 days for severe sepsis
and 11 days for sepsis. Although higher levels of uric acid were observed in patients who did not survive, this
difference did not reach statistical significance in predicting mortality. These findings underscore the potential
utility of serum uric acid as a marker in assessing severity and prognosis in sepsis, warranting further
investigation into its clinical implications.
Conclusion- Hyperuricemia serves as an early marker for predicting morbidity and mortality in sepsis patients.
Incorporating serum uric acid measurement into the clinical management of sepsis could enhance prognostic
accuracy and improve patient outcomes.