This study aimed to investigate the role of serum uric acid (UA) in early identification of the severity, prognosis and complications in patients with severe acute pancreatitis (SAP). The clinical data of SAP patients were collected retrospectively (n=268), and patients were divided into high UA group and low UA group based on the median UA level. Propensity score matching was used to make the baseline data comparable, and 85 patients were selected in each group. Spearman correlation analysis was performed to assess the relationship between UA level and severity and prognosis. The ROC curve was designed to evaluate the ability of UA to predict complications. In the high UA group, disease severity scores were higher, ICU stay and total hospital days were longer. UA levels were found to be positively associated to disease severity scores, ICU stay and total hospital days. The ROC curve revealed that the UA level had an useful predictive value for infectious pancreatic necrosis (IFN). UA level can be used as a convenient indicator of disease severity and IFN risk in SAP patients.

Huan Yi, Fachun Zhou, Shijing Tian, Chang Liu, Sanle Jiang. Correlation of Uric Acid with Disease Severity, Prognosis, and Complications in Patients with Severe Acute Pancreatitis. Frontiers in Medical Science Research (2023) Vol. 5, Issue 4: 23-30. https://doi.org/10.25236/FMSR.2023.050404.

[1] Portelli M, Jones CD. Severe acute pancreatitis: pathogenesis, diagnosis and surgical management. Hepatobiliary & pancreatic diseases international: HBPD INT. 2017; 16(2):155-9.

[2] Appelros S, Lindgren S, Borgström A. Short and long term outcome of severe acute pancreatitis. The European journal of surgery = Acta chirurgica. 2001; 167(4):281-6.

[3] Hong W, Dong L, Huang Q, Wu W, Wu J, Wang Y. Prediction of severe acute pancreatitis using classification and regression tree analysis. Digestive diseases and sciences. 2011; 56(12):3664-71.

[4] Harshit Kumar A, Singh Griwan M. A comparison of APACHE II, BISAP, Ranson's score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterology report. 2018; 6(2):127-31.

[5] Larvin M, McMahon MJ. APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet (London, England). 1989; 2(8656):201-5.

[6] Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive care medicine. 1996; 22(7):707-10.

[7] Eachempati SR, Hydo LJ, Barie PS. Severity scoring for prognostication in patients with severe acute pancreatitis: comparative analysis of the Ranson score and the APACHE III score. Archives of surgery (Chicago, Ill: 1960). 2002; 137(6):730-6.

[8] Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62(1):102-11.

[9] Johnson RJ, Bakris GL, Borghi C, Chonchol MB, Feldman D, Lanaspa MA, et al. Hyperuricemia, Acute and Chronic Kidney Disease, Hypertension, and Cardiovascular Disease: Report of a Scientific Workshop Organized by the National Kidney Foundation. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2018; 71(6):851-65.

[10] Ejaz AA, Mu W, Kang DH, Roncal C, Sautin YY, Henderson G, et al. Could uric acid have a role in acute renal failure? Clinical journal of the American Society of Nephrology: CJASN. 2007; 2(1):16-21.

[11] Lee HW, Choi SM, Lee J, Park YS, Lee CH, Yim JJ, et al. Serum Uric Acid Level as a Prognostic Marker in Patients with Acute Respiratory Distress Syndrome. Journal of intensive care medicine. 2019; 34(5):404-10.

[12] Dunkelgrun M, Welten GM, Goei D, Winkel TA, Schouten O, van Domburg RT, et al. Association between serum uric acid and perioperative and late cardiovascular outcome in patients with suspected or definite coronary artery disease undergoing elective vascular surgery. The American journal of cardiology. 2008; 102(7):797-801.

[13] Wang J, Wang Y, Li X, Huang Y, Sun X, Wang Q, et al. Serum uric acid is associated with disease severity and may predict clinical outcome in patients of pulmonary arterial hypertension secondary to connective tissue disease in Chinese: a single-center retrospective study. BMC pulmonary medicine. 2020; 20(1):272.

[14] Kir E, Güven Atici A, Güllü YT, Köksal N, Tunçez İ H. The relationship between serum uric acid level and uric acid/creatinine ratio with chronic obstructive pulmonary disease severity (stable or acute exacerbation) and the development of cor pulmonale. International journal of clinical practice. 2021; 75(8):e14303.

[15] Zou Y, Zhao L, Zhang J, Wang Y, Wu Y, Ren H, et al. Association between serum uric acid and renal outcome in patients with biopsy-confirmed diabetic nephropathy. Endocrine connections. 2021; 10(10):1299-306.

[16] Zhang X, Liu L, Liang R, Jin S. Hyperuricemia is a biomarker of early mortality in patients with chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2015; 10: 2519-23.

[17] Liu S, Zhong Z, Liu F. Prognostic value of hyperuricemia for patients with sepsis in the intensive care unit. Scientific reports. 2022; 12(1):1070.

[18] Flati G, Andrén-Sandberg A, La Pinta M, Porowska B, Carboni M. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas. 2003; 26(1):8-14.

[19] Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive care medicine. 2013; 39(7):1190-206.

[20] He SS, Li D, He QY, Chen XP, Lin YX, Yu YW, et al. Establishment of Early Multi-Indicator Prediction Models of Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis. Gastroenterology research and practice. 2022; 2022: 5142473.

[21] Liu D, Yun Y, Yang D, Hu X, Dong X, Zhang N, et al. What Is the Biological Function of Uric Acid? An Antioxidant for Neural Protection or a Biomarker for Cell Death. Disease markers. 2019; 2019: 4081962.

[22] Kimura Y, Tsukui D, Kono H. Uric Acid in Inflammation and the Pathogenesis of Atherosclerosis. International journal of molecular sciences. 2021; 22(22).

[23] Crișan TO, Cleophas MC, Oosting M, Lemmers H, Toenhake-Dijkstra H, Netea MG, et al. Soluble uric acid primes TLR-induced proinflammatory cytokine production by human primary cells via inhibition of IL-1Ra. Annals of the rheumatic diseases. 2016; 75(4):755-62.

[24] Martinon F, Pétrilli V, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006; 440(7081):237-41.

[25] Braga TT, Foresto-Neto O, Camara NOS. The role of uric acid in inflammasome-mediated kidney injury. Current opinion in nephrology and hypertension. 2020; 29(4):423-31.

[26] Keenan T, Blaha MJ, Nasir K, Silverman MG, Tota-Maharaj R, Carvalho JA, et al. Relation of uric acid to serum levels of high-sensitivity C-reactive protein, triglycerides, and high-density lipoprotein cholesterol and to hepatic steatosis. The American journal of cardiology. 2012; 110(12):1787-92.

[27] Peraçoli MT, Bannwart CF, Cristofalo R, Borges VT, Costa RA, Witkin SS, et al. Increased reactive oxygen species and tumor necrosis factor-alpha production by monocytes are associated with elevated levels of uric acid in pre-eclamptic women. American journal of reproductive immunology (New York, NY: 1989). 2011;66(6):460-7.

[28] Guo W, Song F, Chen S, Zhang L, Sun G, Liu J, et al. The relationship between hyperuricemia and contrast-induced acute kidney injury undergoing primary percutaneous coronary intervention: secondary analysis protocol for the ATTEMPT RESCIND-1 study. Trials. 2020; 21(1):567.

[29] Lisowska-Myjak B. Serum and urinary biomarkers of acute kidney injury. Blood purification. 2010; 29(4):357-65.

[30] Yu MA, Sánchez-Lozada LG, Johnson RJ, Kang DH. Oxidative stress with an activation of the renin-angiotensin system in human vascular endothelial cells as a novel mechanism of uric acid-induced endothelial dysfunction. Journal of hypertension. 2010;28(6):1234-42.

[31] Kadowaki D, Sakaguchi S, Miyamoto Y, Taguchi K, Muraya N, Narita Y, et al. Direct radical scavenging activity of benzbromarone provides beneficial antioxidant properties for hyperuricemia treatment. Biological & pharmaceutical bulletin. 2015; 38(3):487-92.

[32] Cheungpasitporn W, Thongprayoon C, Harrison AM, Erickson SB. Admission hyperuricemia increases the risk of acute kidney injury in hospitalized patients. Clinical kidney journal. 2016;9(1):51-6.

[33] Zhu C, Zhang S, Zhong H, Gu Z, Kang Y, Pan C, et al. Intra-abdominal infection in acute pancreatitis in eastern China: microbiological features and a prediction model. Annals of translational medicine. 2021; 9(6):477.

[34] Husu HL, Valkonen MM, Leppäniemi AK, Mentula PJ. Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit-Treated Patients with Necrotizing Severe Acute Pancreatitis. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract. 2021; 25(9):2289-98.

[35] Yu X, Pan Y, Fei Q, Lin X, Chen Z, Huang H. Serum soluble PD-1 plays a role in predicting infection complications in patients with acute pancreatitis. Immunity, inflammation and disease. 2021; 9(1):310-8.

[36] Wu J, Wei Z, Cheng P, Qian C, Xu F, Yang Y, et al. Rhein modulates host purine metabolism in intestine through gut microbiota and ameliorates experimental colitis. Theranostics. 2020; 10(23):10665-79.

[37] Lv Q, Xu D, Ma J, Wang Y, Yang X, Zhao P, et al. Uric acid drives intestinal barrier dysfunction through TSPO-mediated NLRP3 inflammasome activation. Inflammation research: official journal of the European Histamine Research Society [et al]. 2021; 70(1):127-37.

[38] Chen M, Lu X, Lu C, Shen N, Jiang Y, Chen M, et al. Soluble uric acid increases PDZK1 and ABCG2 expression in human intestinal cell lines via the TLR4-NLRP3 inflammasome and PI3K/Akt signaling pathway. Arthritis research & therapy. 2018; 20(1):20.