J Korean Med Sci.  2020 Jul;35(28):e222. 10.3346/jkms.2020.35.e222.

Comparison of Serum Uric Acid in Major Depressive Disorder and Bipolar Disorder: a Retrospective Chart Review Study

• Kim S
• Rhee SJ
• Song Y
• Ahn YM

• KMID: 2504361
• DOI: http://doi.org/10.3346/jkms.2020.35.e222

Abstract

Background
Uric acid (UA) has been suggested as a possible biomarker of bipolar disorder (BD) in recent studies. We aimed to provide a clearer comparison of UA levels between BD and major depressive disorder (MDD).
Methods
We retrospectively reviewed the medical chart records of psychiatric inpatients aged 19–60 years, whose main discharge diagnoses were either MDD or BD, with an admission between January 1, 2015 and December 31, 2018 at Seoul National University Hospital. Data such as sex, age, body mass index (BMI), medication usage, and serum UA levels were extracted. Patients with medical conditions or on medications that could influence UA levels were excluded. Age, sex, BMI, and psychiatric drug usage were considered in the comparison of serum UA between MDD and BD patients.
Results
Our sample consisted of 142 MDD patients and 234 BD patients. The BD patients had significantly higher serum UA levels compared to the MDD patients, without accounting for other confounding variables (5.75 ± 1.56 mg/dL vs. 5.29 ± 1.59 mg/dL, P = 0.006). T-test comparisons between psychiatric medication users and non-users revealed that mood stabilizers and antipsychotics may be relevant confounding factors in our sample analysis. The likelihood of BD diagnosis was significantly correlated with higher UA levels (odds ratio, 1.410; 95% confidence interval, 1.150–1.728; P = 0.001) when accounting for sex, age, and BMI in the logistic regression analysis. Also, accounting for mood stabilizers or antipsychotics, the likelihood of BD diagnosis was still significantly correlated with higher UA levels.
Conclusion
Our study confirms that BD patients are significantly more likely to show higher serum UA levels than MDD patients. The high UA levels in BD point to purinergic dysfunction as an underlying mechanism that distinguishes BD from MDD. Further research is recommended to determine whether UA is a trait or a state marker and whether UA correlates with the symptoms and severity of BD.

Keyword

Bipolar Disorder; Major Depressive Disorder; Uric Acid

Figure

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  Fig. 1 Flowchart of sample selection. From 914 total available inpatient data entries, multiple admissions were excluded in order to include only the most recent admission entry of each patient. From the 542 patients, those with medical conditions and those on medications affecting uric acid levels were excluded. The final eligible patient number was 376, including 142 patients with major depressive disorder and 234 patients with bipolar disorder.MDD = major depressive disorder, BD = bipolar disorder, UA = uric acid.aMedical conditions: cancer, autoimmune disorder, liver disorder, gout, hypertension, hypercholesterolemia, diabetes, and thyroid disorder. Medications: corticosteroids, anti-inflammatory drugs, and narcotics.

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