From the Guidelines
High uric acid levels are not typically caused by infections themselves, but certain infections can be associated with elevated uric acid levels due to increased cell turnover or metabolic changes. Infections that may be associated with hyperuricemia include severe pneumonia, sepsis, and tuberculosis, particularly during the acute phase when there is significant tissue breakdown and cell death 1. HIV infection can also be associated with hyperuricemia, especially in patients on certain antiretroviral medications. Additionally, some parasitic infections like malaria can cause elevated uric acid levels due to the destruction of red blood cells. It's essential to note that while these infections may be associated with transient elevations in uric acid, the primary management should focus on treating the underlying infection rather than specifically targeting the uric acid levels. Once the infection resolves, uric acid levels typically return to baseline. In patients with persistently high uric acid levels after infection resolution, other causes such as kidney dysfunction, certain medications, or metabolic disorders should be considered 1. Some key points to consider when evaluating hyperuricemia in the context of infections include:
- The role of cell turnover and metabolic changes in the development of hyperuricemia
- The potential for certain infections to cause transient elevations in uric acid levels
- The importance of treating the underlying infection rather than specifically targeting uric acid levels
- The need to consider other causes of persistently high uric acid levels after infection resolution. The most recent and highest quality study on this topic is from 2020, which emphasizes the importance of identifying person-specific risk factors for hyperuricaemia in patients with gout, including chronic kidney disease, overweight, and consumption of excess alcohol 1. Overall, the management of hyperuricemia in the context of infections should prioritize treating the underlying infection and addressing any underlying risk factors or comorbidities.
From the FDA Drug Label
Hyperuricemia may be primary, as in gout, or secondary to diseases such as acute and chronic leukemia, polycythemia vera, multiple myeloma, and psoriasis The infections with high uric acid levels in patients are not directly mentioned in the provided drug labels. However, hyperuricemia can be secondary to diseases such as:
- Acute leukemia
- Chronic leukemia
- Polycythemia vera
- Multiple myeloma
- Psoriasis Note that these are not necessarily infections, but rather diseases that can cause hyperuricemia. 2
From the Research
Infections Associated with High Uric Acid Levels
- Sepsis: High uric acid levels have been linked to an increased risk of acute kidney injury (AKI) in sepsis patients 3, 4.
- Acute kidney injury: Hyperuricemia has been recognized as a potentially modifiable risk factor for AKI, including that associated with cardiovascular surgery, radiocontrast administration, rhabdomyolysis, and heat stress 5, 6.
- Gout: Hyperuricemia is a major risk factor for the development of gout, an increasingly common condition 7.
- Metabolic syndrome, diabetes, hypertension, and kidney and cardiovascular diseases: Hyperuricemia is associated with these conditions, although the exact mechanisms are not fully understood 7.
Key Findings
- Hyperuricemia is an independent predictor of poor outcomes in sepsis patients, including increased severity of illness, AKI, prolonged ICU stays, and mortality 3.
- High uric acid levels are associated with an increased risk of AKI in critically ill patients with sepsis 4.
- Lowering uric acid levels may have potential benefits in reducing the risk of AKI and improving kidney function 5, 6.
Associated Conditions
- Chronic kidney disease: Hyperuricemia is associated with an increased risk of chronic kidney disease, and lowering uric acid levels may help slow disease progression 7, 5.
- Cardiovascular disease: Hyperuricemia is associated with an increased risk of cardiovascular disease, and lowering uric acid levels may help improve cardiovascular outcomes 7, 6.