Predictive value of uric acid and lactate dehydrogenase for maternal morbidity in preeclampsia: a retrospective case-control study

Objective Preeclampsia is a major cause of global maternal morbidity and mortality. This study aims to determine whether readily available and inexpensive biomarkers, serum uric acid (UA), and lactate dehydrogenase (LDH), show a significant association with severe maternal morbidity in established preeclampsia. Materials and methods In this retrospective Case-Control study (2017-2022), 200 singleton pregnancies with ACOG-defined preeclampsia and 200 age and gestational age-comparable healthy controls delivered at a tertiary center were analyzed. UA and LDH were serially measured (minimum, average, maximum). Maternal morbidities (acute kidney injury, pulmonary oedema, neurological seizures, vision loss) were adjudicated using KDIGO, Berlin and ACOG criteria. Exclusions HELLP syndrome, chronic hypertension, diabetes, renal/liver/cardiac disease, systemic infection. Multivariable logistic regression adjusted for age, BMI, parity, and mean systolic BP. Results Mean UA (5.8 ± 1.3 vs. 4.4 ± 1.1 mg/dL) and LDH (410.7 ± 194.0 vs. 267.2 ± 92.0 IU/L) were higher in preeclampsia ( p < 0.001). BMI was also higher in the preeclampsia group (29.5 ± 4.2 vs. 26.1 ± 3.8 kg/m 2 , p < 0.001). UA independently predicted acute kidney injury (aOR 3.21, 95 % CI 2.50–4.12) at 6.3 mg/dL (AUC 0.924, 97.8 % NPV). UA ≥ 8.0 mg/dL was 100 % sensitive for seizures; UA ≥ 6.1 mg/dL for vision loss (90.9 % sensitivity). Additionally, an average LDH level ≥ 516.4 IU/L showed high utility for ruling out pulmonary edema (99.4% NPV). LDH did not retain independent predictive significance for most outcomes in multivariable modeling. No preeclampsia-related deaths occurred. Conclusion In a Middle Eastern cohort, UA is an inexpensive, widely available marker that is significantly associated with severe maternal morbidity in established preeclampsia, whereas LDH, while reflecting disease severity, did not add independent predictive value for most outcomes after adjustment. Prospective multicentre validation is required.