Hyperuricemia in Tuberculosis Patients Treated with Pyrazinamide

Abstract

Background: Pyrazinamide (PZA), a cornerstone of first-line anti-tuberculosis therapy, is associated with a high incidence of hyperuricemia, a potentially overlooked metabolic complication that may impact treatment adherence. Despite its frequent use, limited data exists on the demographic and clinical predictors of PZA-induced hyperuricemia in the local Pakistani population, creating a gap in risk-based monitoring strategies. Objective: This study aimed to determine the prevalence and associated factors of Pyrazinamide-induced hyperuricemia in patients with pulmonary tuberculosis, focusing on demographic variables (age, gender) and clinical indicators (pleural fluid analysis, ADA estimation, radiological findings). Methods: A descriptive cross-sectional study was conducted at the Pulmonology Department of Khyber Teaching Hospital, Peshawar, enrolling 46 patients aged 18–65 years diagnosed with pulmonary tuberculosis. Patients with renal, hepatic, or rheumatologic conditions were excluded. Serum uric acid (SUA) levels were recorded at 0, 2, 6, and 8 weeks of Pyrazinamide treatment. Pleural fluid, ADA levels, and imaging were assessed. Ethical approval was obtained, and all procedures adhered to the Declaration of Helsinki. Data were analyzed using SPSS v27; chi-square and paired t-tests assessed associations, with p < 0.05 considered significant. Results: The mean age was 38.2 ± 10.5 years; 60.9% were male. Statistically significant associations were found between hyperuricemia and age (p = 0.001), gender (p = 0.049), pleural fluid analysis (p = 0.005), ADA estimation (p = 0.014), and radiological/histopathological findings (p = 0.034). Treatment duration was not significantly associated (p = 0.235). Conclusion: Pyrazinamide-induced hyperuricemia is significantly associated with demographic and disease severity markers in TB patients. Routine uric acid monitoring, especially in middle-aged males and those with pleural or radiological involvement, may improve therapeutic safety and adherence.