The Relationship between Serum Uric Acid and Severity of Chronic Obstructive Pulmonary Disease (COPD)

Document Type : Original Article


1 Medical Student, Department of Internal Medicine, Birjand University of Medical Sciences, Birjand, Iran

2 Internal Medicine, Department of Internal Medicine, Birjand University of Medical Sciences, Birjand, Iran

3 Fellowship of Internal Medicine, Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad,Iran


Introduction: Some evidence exists about the possible relationship between the serum uric acid (UA) and exacerbation of the chronic obstructive pulmonary disease (COPD). Present study intended to compare the COPD-related variables and the one-year outcome between the two groups of patients with the high and low UA.
Material and Methods: This cohort study consisted of 112 patients with COPD exacerbation. The participants were categorized into low (i.e., Afterwards, the patients were followed up for one year and some other variables such as taking oral antibiotic for respiratory infections, admission to hospital or ICU due to COPD exacerbation, and survival were documented monthly.
Results: The mean serum level of creatinine was significantly higher in the high UA group (1.1±0.4 mg/dL) than the low UA group (1.01±0.1 mg/dL) (P=0.02). No significant difference was observed between the two groups regarding the GOLD classification, FEV1, oxygen saturation, pCO2, and echocardiographic indices. In the one-year follow-up, 42 cases (82.4%) of the high UA group and 39 patients (63.9%) of the low UA group reported taking oral antibiotics, which was indicative of a significant difference (P=0.03). Hospital admission was likewise significantly higher in the high UA group (30 patients, 58.8%) than in the low UA group (23 cases, 37.7%) (P= 0.03).
Conclusion: Those patients with the UA level of ≥ 6.5 mg/dL experienced more hospital admission and were more likely to take oral antibiotics for respiratory infections during a year. However, UA did not correlate with FEV1 or COPD severity.


  1. Centers for Disease Control and Prevention (CDC). Chronic obstructive pulmonary disease among adults--United States, 2011. MMWR Morb Mortal Wkly Rep. 2012; 61:938-43.
  2. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370:741-50.
  3. Gershon AS, Warner L, Cascagnette P, Victor JC, To T. Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study. Lancet. 2011; 378:991-6.
  4. Kochanek KD, Xu J, Murphy SL, Minino AM, Kung HC. Deaths: final data for 2009. Natl Vital Stat Rep. 2011; 60:1-116.
  5. Lange P, Colak Y, Ingebrigtsen TS, Vestbo J, Marott JL. Long-term prognosis of asthma, chronic obstructive pulmonary disease, and asthma-chronic obstructive pulmonary disease overlap in the Copenhagen city heart study: a prospective population-based analysis. Lancet Respir Med. 2016; 4:454-62.
  6. Drummond MB, Hansel NN, Connett JE, Scanlon PD, Tashkin DP, Wise RA. Spirometric predictors of lung function decline and mortality in early chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012; 185:1301-6.
  7. Kohansal R, Martinez-Camblor P, Agusti A, Buist AS, Mannino DM, Soriano JB. The natural history of chronic airflow obstruction revisited: an analysis of the Framingham offspring cohort. Am J Respir Crit Care Med. 2009; 180:3-10.
  8. Ong KC, Earnest A, Lu SJ. A multidimensional grading system (BODE index) as predictor of hospitalization for COPD. Chest. 2005; 128:3810-6.
  9. Ahmadi-Abhari S, Kaptoge S, Luben RN, Wareham NJ, Khaw KT. Longitudinal association of C-reactive protein and lung function over 13 years: The EPIC-Norfolk study. Am J Epidemiol. 2014; 179:48-56.
  10.  Bartziokas K, Papaioannou AI, Loukides S, Papadopoulos A, Haniotou A, Papiris S, et al. Serum uric acid as a predictor of mortality and future exacerbations of COPD. Eur Respir J. 2014; 43:43-53.
  11. Durmus Kocak N, Sasak G, Aka Akturk U, Akgun M, Boga S, Sengul A, et al. Serum Uric Acid Levels and Uric Acid/Creatinine Ratios in Stable Chronic Obstructive Pulmonary Disease (COPD) patients: are these parameters efficient predictors of patients at risk for exacerbation and/or severity of disease? Med Sci Monit. 2016; 22:4169-76.
  12. Embarak S, Sileem AE, Abdrabboh M, Mokhtar A. Serum uric acid as a biomarker for prediction of outcomes of patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease. Egypt J Bronchol. 2014; 8:115.
  13.  Zhang X, Liu L, Liang R, Jin S. Hyperuricemia is a biomarker of early mortality in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015; 10:2519-23.
  14.  Garcia-Pachon E, Padilla-Navas I, Shum C. Serum uric acid to creatinine ratio in patients with chronic obstructive pulmonary disease. Lung. 2007; 185:21-4.
  15. Shimizu Y, Nagaya N, Satoh T, Uematsu M, Kyotani S, Sakamaki F, et al. Serum uric acid level increases in proportion to the severity of pulmonary thromboembolism. Circ J. 2002; 66:571-5.
  16.  Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016; 213:8-14.
  17.  Leyva F, Anker S, Swan JW, Godsland IF, Wingrove CS, Chua TP, et al. Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure. Eur Heart J. 1997; 18:858-65.
  18. Ghaemi-Oskouie F, Shi Y. The role of uric acid asan endogenous danger signal in immunity and inflammation. Curr Rheumatol Rep. 2011; 13:160-6.
  19. Gruffydd-Jones K. GOLD guidelines 2011: what are the implications for primary care? Prim Care Respir J. 2012; 21:437-41.
  20. Horsfall LJ, Nazareth I, Petersen I. Serum uric acid and the risk of respiratory disease: a population-based cohort study. Thorax. 2014; 69:1021-6.
  21.  Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation. 2003; 107:1514-9.
  22. Saito H, Nishimura M, Shibuya E, Makita H, Tsujino I, Miyamoto K, et al. Tissue hypoxia in sleep apnea syndrome assessed by uric acid and adenosine. Chest. 2002; 122:1686-94.
  23. Nicks ME, O'Brien MM, Bowler RP. Plasma antioxidants are associated with impaired lung function and COPD exacerbations in smokers. COPD. 2011; 8:264-9.