Abnormal Uric Acid Levels as a Marker for Sepsis and its Severity

Background: A clinical observation of abnormal serum levels of uric acid (UA) in children hospitalized with sepsis led to this research. We aimed to evaluate the prevalence of this phenomenon and to investigate its association with the severity of the disease.

Design: This is a retrospective, controlled study comprising 640 patients with fever and positive blood cultures who attended Schneider Children’s Medical Center of Israel during 2016-2017. Only previously healthy patients were included and divided into 2 groups: 1) sepsis related to the pathogen detected by a blood culture (true bacteremia); 2) illness unrelated to the identified pathogen. The prevalence of abnormal UA levels at presentation and the prevalence of hypouricemia at any time during hospitalization (trough hypouricemia) were compared between the groups. Furthermore, we examined the association between hypouricemia and different indices of disease severity.

Results: 165 patients were enrolled; 86 in the febrile illness group and 79 in the sepsis group. Abnormal levels of UA at presentation were more prevalent in the sepsis group (p=0.006). Trough hypouricemia was more prevalent in the sepsis group (25% Vs 8%, p=0.003). In this group hypouricemia was associated with a high rate of admissions to intensive care unit (p=0.01), longer hospitalization (p=0.05), hypophosphatemia (p<0.001) and elevated C-reactive protein (p=0.03).

Conclusion: Abnormal UA levels at the presentation of febrile illness in children can be used as an additional marker of sepsis. Moreover, hypouricemia observed during hospitalization is common in children with sepsis and is associated with a more severe disease.