S2924 Allopurinol Therapy in Cirrhotic Patients: Impact on Uric Acid and Liver Enzymes

Introduction: Hyperuricemia is frequently observed in cirrhosis and is associated with oxidative stress, inflammation, and endothelial dysfunction, potentially contributing to disease progression. Allopurinol, a xanthine oxidase inhibitor, may mitigate these mechanisms. This study aimed to evaluate the association between allopurinol use and changes in clinical and biochemical markers among individuals with cirrhosis using a large population-based cohort. Methods: Using the TriNetX research network, we identified adults with confirmed cirrhosis. Allopurinol exposure was defined as use during ≥5 clinical encounters after cirrhosis diagnosis. Patients were matched 1:1 using propensity scores based on demographics, comorbidities, cirrhosis etiology, medication use, and baseline labs. The primary outcomes included changes in uric acid, liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST], albumin, total bilirubin), and renal function (creatinine) over a mean follow-up of 135 days. Triglycerides were also assessed as a metabolic marker. Results: After matching, 5358 patients were included in each group. Allopurinol use was associated with greater reductions in serum uric acid (−2.1 mg/dL vs −0.4 mg/dL, P < 0.01), ALT (−14.2 U/L vs −6.5 U/L), and AST (−12.3 U/L vs −4.8 U/L) compared to controls. Albumin levels increased and total bilirubin decreased in the allopurinol group, though these changes were not statistically significant. No significant changes in serum creatinine were observed, suggesting no adverse renal impact. Conclusion: In this large, matched cohort of cirrhotic patients, allopurinol use was associated with significant improvements in uric acid levels and favorable trends in liver enzymes. These findings support a potential biochemical benefit of allopurinol in cirrhosis and warrant prospective investigation into its clinical implications.