Low Serum Uric Acid Levels are Associated with Severe Diabetic Foot Infection: A Cross-Sectional Study from China

<b>Diabetic</b> foot ulcers (DFUs) are among the most serious complications of diabetes which are associated with high disability and mortality rates. This study aims to investigate the associations between uric acid (UA) levels and diabetic foot ulcer (DFU) characteristics. In total, 1820 participants with DFUs were included in this study; 192 and 1628 participants were included in the hyperuricemia group (HUA, UA > 420 µmol/L) and the nonhyperuricemia group (NHUA, UA ≤420 µmol/L), respectively. The NHUA group was divided into a middle-UA subgroup (SMUA, 420 µmol/L ≥ UA ≥ 180 µmol/L; 304 individuals) and a low-UA subgroup (SLUA, UA <180 µmol/L; 1324 individuals). There were no significant differences in the rates of deep ulcers, severe infection or amputation between NHUA and HUA. In univariate analysis of subgroups, the differences in the rates of deep ulcers, severe infection and amputation were significant. After adjusting for confounders (sex, fasting glucose level, diabetes duration, eGFR, deep ulcers and severe infection) in multivariate analysis, the severe infection rate (OR = 4.0, 95%CI 1.6-10.0, P < 0.01) was still significantly greater in the SLUA group than in the SMUA group while the rate of deep ulcers (OR =2.4, 95%CI 1.0-6.1, P = 0.06) and amputation (OR =1.1, 95%CI 0.3-4.3, P = 0.91) showed non-statistical difference. UA levels below 180 µmol/L can be a risk factor for severe infection in DFUs.