The Relationship Between Albumin, Uric Acid, and Uric Acid/Albumin Ratio and the Severity of Hypoxaemia in Patients with Chronic Obstructive Pulmonary Disease During Acute Exacerbation Periods

Abstract

Objective Studies in patients with chronic obstructive pulmonary disease have demonstrated an association with serum uric acid levels. In this study, we aimed to evaluate whether uric acid and uric acid/albumin levels could be used as predictors of disease severity in and execerbation COPD patients according to COPD stages and between COPD and healthy individuals. Material and Method This study included patients with COPD and healthy controls. Serum uric acid levels and uric acid/albumin ratios were assessed in each group, and their correlations with study parameters were investigated. Results A total of 141 individuals were included in our study; 103 of these were COPD patients (87 men and 16 women) with a mean age of 65.60 ± 9.17, and 38 were healthy controls. When comparing mild and moderate COPD (GOLD1, GOLD2) with severe and profound COPD (GOLD3, GOLD4), CRP levels and annual exacerbation numbers were statistically significantly higher in the advanced COPD group (p<0.001 and p=0.042, respectively). When the COPD group was compared with the healthy group, urea, creatinine, uric acid/albumin, CRP, WBC, and eosinophil percentage were higher in the COPD group (p=0.002, p=0.010, p<0.001, p=0.002, p=0.018, p=0.037, respectively). When comparing the acute exacerbation and stable period of COPD, uric acid/albumin, CRP, and leukocyte counts were found to be higher in the acute period (p=0.001, p=0.048, p=0.042). Conclusion Serum uric acid levels and uric acid/albumin ratios in COPD patients were considered to be useful in predicting COPD ex-acerbation risk and disease severity.

Keywords

• Albumin
• Chronic obstructive pulmonary disease
• pulmonary function test
• Uric acid

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

Ethical Statement

Ethical Approval This study was Ethics Committee approval was obtained from Harran University with numbered HRÜ/25.10.32 and dated 2025. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Consent to Participate and Publish Written informed consent to participate and publish was obtained from all individual participants or legal guardians included in the study.

Thanks

I would like to thank the patients, their relatives and healthcare workers who volunteered to participate.

References

1. 1. Agustí A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. American Journal of Respiratory and Critical Care Medicine 2023;207(7):819-837. https://doi.org/10.1164/rccm.202301-0106PP
2. 2. Celli BR, Criner GJ. Chronic obstructive Pulmonary Disease in the Twenty-first century. Clinics in Chest Medicine 2020;41(3):xv-xvii. https://doi.org/10.1016/j.ccm.2020.06.015
3. 3. Abalı H, Önür S T, Akyıl F T et al. Are Uric Acid and Uric Acid Creatinine Ratio Predictors for Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease? Medical Journal of Western Black Sea,2022; 6(2):142-149. https://doi.org/10.29058/mjwbs.1027675.
4. 4. Elsayed NM, Nakashima JM, Poslethwait EM. Measurement of uric acid as a marker of oxygen tension in the lung. Arch Biochem Biophys. 1993;(302):228-32. https://doi.org/10.1006/abbi.1993.1204.
5. 5. Barmehziar S, Fadaii A, Samadian F, et al. Investigating the role of uric acid and uric acid‐to‐creatinine ratio as a predictive factor of chronic obstructive pulmonary disease exacerbation in 2019. The Clinical Respiratory Journal. 2023;17(10):1025-37 https://doi.org/10.1111/crj.13689.
6. 6. Soman MK, Chakkamadathil JK, Noorayingarath H, et al. Serum Uric Acid as a Biomarker in Patients Admitted with Acute Exacerbation of Chronic Obstructive Pulmonary Disease to a Tertiary Hospital, Kerala. Journal of Advanced Lung Health 2025;5(1):15-19. Doi: 10.4103/jalh.jalh_25_24.
7. 7. Yamaya M, Usami O, Nakayama S et al. Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study. Int J Chron Obstruct Pulmon Dis. 2020; 22(15):857-868. https://doi.org/10.2147/COPD.S238457.
8. 8. Li H, Chen Y. Serum uric acid level as a biomarker for chronic obstructive pulmonary disease: a meta-analysis. J Int Med Res. 2021;49(1):300060520983705. doi: 10.1177/0300060520983705.

9. 9. Rumora L, Hlapčić I, Popović-Grle S et al. Uric acid and uric acid to creatinine ratio in the assessment of chronic obstructive pulmonary disease: Potential biomarkers in multicomponent models comprising IL-1beta. PLoS One 2020;(5):15(6):e0234363 doi: 10.1371/journal.pone.0234363
10. 10. Zhao T, Lv T. Correlation between serum bilirubin, blood uric acid, and C-reactive protein and the severity of chronic obstructive pulmonary disease. J Health Popul Nutr. 2024 Jul 8;43(1):105 https://doi.org/10.1186/s41043-024-00593-5.
11. 11. Zhang X, Liu L, Liang R, et al. Hyperuricemia is a biomarker of premature death in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10(1):2519–2523 https:// doi.org/10.2147/COPD.S87202
12. 12. Bartziokas K, Papaioannou AI, Loukides S et al. Serum uric acid as a predictor of deaths and exacerbations of COPD. Eur Respir J. 2014;43(1):43–53. doi: 10.1183/09031936.00209212.
13. 13. Ahn KM, Lee SY, Lee SH, et al. Lung function decline is associated with serum uric acid in Korean health screening individuals. Sci Rep. 2021;11(1):10183. https://doi.org/10.1038/s41598-021-89678-3.
14. 14. Kir E, Atici AG, Güllü YT et al. 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. https://doi.org/10.1111/ijcp.14303.
15. 15. Büyükbayram G, Yüceer Ö, Oymak FS. The Relationship between Serum Uric Acid Levels and Early Mortality in Chronic Obstructive Pulmonary Disease Cases during Exacerbation. Sarcoidosis Vasc Diffuse Lung Dis. 2022;39(2): e2022014. doi: 10.36141/svdld.v39i2.12127.
16. 16. Hallin R, Koivisto-Hursti UK, Lindberg E, et al. Nutritional status, dietary energy intake, and exacerbation risk in patients with chronic obstructive pulmonary disease (COPD). Respir Med. 2006;(100):561–567 https://doi.org/10.1016/j.rmed.2005.05.020.
17. 17. Papadopoulos A, Bartziokas K, Haniotou A, et al. Serum uric acid and uric acid/creatinine ratio in exacerbations of COPD. Eur Respir J 2014;38(Suppl 55):911 https://doi.org/10.1183/13993003/erj.38.Suppl_55.p911
18. 18. Aida Y, Shibata Y, Osaka D, et al. The Relationships between serum uric acid and spirometric values in health check-up participants: the Takahata study. International J Med Sci. 2011;8(6):470–78. doi: 10.7150/ijms.8.470.
19. 19. Yang H, Wang Z, Xiao S, et al. Association between serum uric acid and lung function in people with and without chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease 2022;17:1069-1080. doi: 10.2147/COPD.S356797
20. 20. Fukuhara A, Saito J, Sato S, et al. The Association Between Risk of Airflow Limitation and Serum Uric Acid Measured at Medical Health Check-Ups. Int J Chron Obstruct Pulmon Dis 2017;12:1213–1219. https://doi.org/10.2147/COPD.S126249.