The use of uric acid as biomarker in preeclampsia patients and its association with disease severity and adverse neonatal outcomes
Biochemical markers, Hyperuricemia, Gestational hypertension, Low birth weight newborn.
Preeclampsia (PE), due to its systemic pathophysiology, is categorized as one of the main causes of perinatal/maternal morbidity and mortality due to its systemic pathophysiology. Overall, clinical resources available nowadays are used under diagnostic criteria and do not reflect the severity of the underlying disease or, yet, the immediate and remote risks that may affect the maternal-fetal binomial. Thus, the development of clinical and laboratory strategies should focus on anticipating PE severity, like the use of biomarkers, as the uric acid mainly for its measurement simplicity and lower cost, which allow it to be easily inserted in screening protocols. However, although some scholars have reported hyperuricemia – HU (uric acid ≥ 6 mg/dL) as PE severity predictor, general findings remain conflicting. This context motivated the realization of this dissertation, which presents a literature review chapter, addressing high-risk pregnancies, with an emphasis on PE, followed by an original article. The purpose of the article is to evaluate the use of uric acid as biomarker in PE patients and its association with disease severity and adverse neonatal outcomes. It is a controlled cross-sectional study, from a convenience sample of pregnant women with preeclampsia attended at a high-risk maternity hospital in Alagoas, Brazil. Information about gestational, and biochemical parameters was collected before delivery, while perinatal outcomes, after delivery, through a structured questionnaire. The sample comprised 267 pregnant women with PE. HU was observed in 25.8% of cases; it was associated with black pregnant women (p=0.014) and with primiparity (p=0.007). Uric acid was able to predict the behavior of some biomarkers, mainly of creatinine (F = 10.14, p = 0.0016; R² = 0.0388), urea (F = 50.15, p <0.0001; R² = 0.1753), ferritin (F = 10.29, p = 0.0016; R² = 0.0541), globulin (F = 0.0437, p = 0.0017; R² = 0.0437), and albumin (F = 0.1797, p <0.0001; R² = 0.1797). HU was a risk factor for cesarean delivery (p=0.030), prematurity (p=0,001), low birth weight (p<0.001) and small for gestational age (p=0.020). Conclusion: High serum UA levels appear to be related to disease severity predictors and to adverse neonatal outcomes.