Uric acid-to-creatinine ratio as an independent prognostic biomarker in acute coronary syndromes: clinical and statistical evidence from a hospital-based study

BACKGROUND: Acute Coronary Syndrome (ACS) is a leading cause of morbidity and mortality worldwide. Prognostic stratification is crucial to guide management. Uric acid (UA) and creatinine (Cr) are individually associated with poor outcomes, but their combined value as a ratio (UA/Cr) remains underexplored. AIMS: Our objective is to evaluate the prognostic significance of UA, Cr, and the UA/Cr ratio in ACS patients for predicting in-hospital severity and complications. METHODS: A short-term prospective observational cohort study was conducted on 134 patients admitted with ACS (56% NSTEMI, 44% STEMI) between July 2024 and July 2025. Demographic, clinical, and biochemical data were collected. Prognostic value was assessed for severity (Killip, GRACE, CRUSADE) and complications (arrhythmia, hemodynamic instability, mortality) using ROC curves and logistic regression. RESULTS: The population (mean age 61.8 ± 11.5 years, 89% male) showed significant associations between UA and Cr with severity scores (p = 0.041 and p = 0.006, respectively). The UA/Cr ratio was significantly higher in patients with arrhythmic complications (7.03 ± 2.98 vs. 5.65 ± 2.22, p = 0.024). ROC analysis revealed UA predicted complications (AUC = 0.69, p = 0.006) overall and in NSTEMI (AUC = 0.784, p = 0.004). Multivariate analysis confirmed UA as an independent predictor of severity (OR = 1.138, p = 0.048) and complications (OR = 1.237, p = 0.026) in NSTEMI. UA/Cr ratio predicted complications in NSTEMI patients with preserved renal function (OR = 1.711, p = 0.041). CONCLUSION: UA is an independent prognostic marker in ACS, especially NSTEMI. The UA/Cr ratio provides incremental prognostic value in patients with preserved renal function and represents a simple, cost-effective tool to improve ACS risk stratification.