Uric Acid and Grip Strength as Predictors of Mortality in Older Adults: A Sex-Stratified Analysis

Abstract Background Sarcopenia and hyperuricemia correlate with negative outcomes in older adults, including increased mortality. While diminished muscle strength predicts functional deterioration and mortality, elevated serum uric acid's prognostic value remains controversial. This study investigated individual and combined effects of reduced handgrip strength and hyperuricemia on all-cause mortality, focusing on sex-specific differences. Methods This retrospective cohort study evaluated 910 individuals aged ≥ 60 years between 2020–2024 at a university hospital. Participants with confounding conditions or interfering medications were excluded. Uric acid was quantified enzymatically and classified into quartiles. Sarcopenia was defined using EWGSOP2 criteria, including handgrip strength and skeletal muscle mass index from bioelectrical impedance analysis. Cox regression and Kaplan-Meier analyses assessed mortality risk. Results The mean age was 71 years, with 66.9% of participants being female. Reduced handgrip strength and elevated UA levels were correlated with detrimental metabolic indicators. Univariate analysis indicated that both low handgrip strength (HR: 1.91, 95% CI: 1.15–3.18) and the highest quartile of uric acid (UA) levels (HR: 1.86, 95% CI: 1.13–3.08) were significant predictors of mortality. Nevertheless, these correlations diminished following multivariable correction. Sex-stratified studies indicated that hyperuricemia persisted as an independent predictor for mortality in females (HR: 3.08; 95% CI: 1.31–7.26; p = 0.010). Conclusion Both diminished grip strength and elevated uric acid levels are associated with increased mortality in older adults, particularly among females. Routine incorporation of sex-specific metabolic and physical performance assessments may enhance risk stratification strategies in geriatric populations.