marginal significanceP = 0.05
In terms of study design, cohort studies showed higher UA levels in severe cases with marginal significance ( P = 0.05, Hedges’ g = 2.49, 95% CI 0.02–4.97, I 2 = 98.11%, 2 studies), while cross-sectional studies did not reach statistical significance ( P = 0.08, Hedges’ g = 4.00, 95% CI − 0.44 to 8.44, I 2 = 99.09%, 4 studies).