Níveis séricos de ácido úrico associados a parâmetros bioquímicos relacionados à gravidade da pré-eclâmpsia e desfechos perinatais adversos

Abstract

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 association of serum uric acid levels with biochemical parameters related to the severity of preeclampsia (PE) and adverse perinatal outcomes. Cross-sectional study. Information about gestational, and biochemical parameters was collected before delivery, while perinatal outcomes, after delivery, through a structured questionnaire, and predefined inclusion and exclusion criteria. The pregnant were divided with hyperuricemia or normouricemia. The sample comprised 267 pregnant women with PE. Hyperuricemia was observed in 25.8% the sample; it was associated with black pregnant women (p=0.014) and with primiparity (p=0.007). Levels of uric acid were higher in early PE than in late PE (p=0.013), but between mild and severe PE, there was no significant difference (p=0.121). Uric acid was able to predict the behavior of some biochemical parameters, mainly of creatinine (AdjR²=0.035; p=0.002), urea (AdjR²=0.171; p=0.001), proteinuria (AdjR²=0.094; p=0.012) globulin (AdjR²=0.039; 0p=0.0017), albumin (AdjR²=0.176; p<0.0001) and CRP (AdjR²=0.001; p<0.001). Hyperuricemia was an associated 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). High serum uric acid levels were associated with early-onset PE, maternal characteristics and adverse perinatal outcomes. In addition, uric acid was predictor of biochemical parameters that reflect the severity of PE.