The janus-faced role of uric acid in COPD: evidence from East Asians population.

Uric acid as the final purine metabolite exhibits both antioxidative and proinflammatory properties. The association between uric acid and chronic obstructive pulmonary disease (COPD) remains ambiguous. This is particularly true within East Asian populations which lack comprehensive evidence. This study synthesizes data from 20 observational studies via a meta-analysis to compare uric acid levels in COPD patients and healthy controls. Furthermore, a two-sample Mendelian randomization (MR) approach was utilized, employing genome-wide association study (GWAS) data from East Asian populations to investigate the genetic causal relationship between uric acid and COPD. The meta-analysis demonstrated that uric acid concentrations in patients with COPD were significantly elevated compared to those in healthy controls (SMD = 1.57, 95% (CI): 1.11-2.02). This disparity was more pronounced in patients undergoing acute exacerbations and those with more severe airflow limitations. Conversely, MR analysis indicated that elevated uric acid levels were associated with a reduced risk of developing COPD (OR = 0.680, 95% CI: 0.543-0.852). The MR findings were corroborated through sensitivity analyses. Genetically predicted higher serum uric acid was causally associated with a lower risk of developing COPD in East Asians, whereas phenotypically elevated uric acid in patients with established COPD was associated with greater disease severity and exacerbation, suggesting distinct roles of uric acid in COPD susceptibility versus disease progression.