A NEW study has found that elevated uric acid levels in children with severe malaria (SM) are associated with significantly increased risks of death and long-term cognitive impairment.
Malaria remains a major global health threat, with 263 million cases and nearly 600,000 deaths worldwide in 2023, disproportionately affecting African children. Researchers from Indiana University School of Medicine, USA, and Makerere University School of Medicine, Uganda, analysed two independent cohorts of Ugandan children with SM and found that 25% had hyperuricaemia (defined as blood uric acid levels ≥7 mg/dL). These children faced higher in-hospital and post-discharge mortality rates and worse cognitive scores, particularly among those under 5 years old.
The study identified haemolysis of infected red blood cells and impaired kidney excretion as the primary drivers of hyperuricaemia. This condition was linked to multiple severe complications, including acute kidney injury, metabolic acidosis, impaired circulation, coma, and intestinal injury. Researchers also observed an increase in harmful Gram-negative gut bacteria, including Escherichia and Shigella, which may contribute to sepsis in affected children.
This study adds to growing concerns over severe malaria treatment challenges, including emerging resistance to first-line therapies. The findings suggest that hyperuricaemia is not just a secondary consequence of severe malaria but may actively worsen disease outcomes. Given the strong correlation between elevated uric acid levels and mortality, researchers are calling for clinical trials to evaluate uric acid-lowering therapies as a potential adjunctive treatment for SM.
Ada Enesco, EMJ
Reference
Bond C et al. Elevated uric acid levels, mortality and cognitive impairment in children with severe malaria. Nat Med. 2025;DOI: 10.1038/s41591-024-03430-8.
