J-Shaped Relationship of Serum Uric Acid with Unfavorable Short-Term Outcomes among Patients with Acute Ischemic Stroke

Abstract

(1) Background: The role of uric acid in stroke outcomes remains inconclusive. (2) Methods: We retrospectively enrolled 3370 patients with acute ischemic stroke. (3) Results: Uric acid level was higher in men than in women. Univariate analyses revealed that the rates of hyperuricemia were higher in all patients and in women for unfavorable outcomes. For death, the hyperuricemia rates were higher in all patients including men and women, and the uric acid levels were also higher in all patients and in women. A J-shaped curve was observed between uric acid and the discharge-modified Rankin Scale score. Patients within Quartiles 1 (<4.1 mg/dL) and 4 (>6.5 mg/dL) of uric acid had higher rates of unfavorable outcomes and death than patients within Quartiles 2 (4.1–5.1 mg/dL) and 3 (5.1–6.2 mg/dL). Multivariable analyses for unfavorable outcomes revealed that Quartile 1 of uric acid was a significant factor in all patients and in men. In men, a significant factor for death was being in Quartile 1 of uric acid. In women, higher levels of uric acid or hyperuricemia (>6.6 mg/dL) were significant factors for death. (4) Conclusions: Lower uric acid levels are a predictor for unfavorable outcomes and death in men, and higher uric acid levels are a predictor for death in women.

Risk factors for ischemic stroke in China: a case-control study

“…Others considered that too low or too high levels of uric acid both had a higher occurrence of ischemic stroke than moderate levels, which had the lowest incidence of ischemic stroke. 28 The association between ischemic stroke and uric acid was found to be positive, negative, U-shaped, or J-shaped, and there were also sex differences between them. However, studies reporting uric acid as a risk factor were more numerous than those reporting it as a protective factor.…”

Serum uric acid and prognosis in acute ischemic stroke: a dose–response meta-analysis of cohort studies

“…The mean serum uric acid levels of the patients were between 288.5 and 348.6 μmol/L. Outcome measures comprised functional outcome ( Lee et al, 2014 ; Zhang et al, 2016 ; Wang et al, 2018 ; Chen et al, 2020 ; Yuan et al, 2020 ; Bai et al, 2022 ; Liu et al, 2022a , b ), mortality ( Wang et al, 2018 ; Chen et al, 2020 ; Bai et al, 2022 ; Liu et al, 2022a ), hemorrhagic transformation ( Chen et al, 2020 ; Song et al, 2020 ; Cheng et al, 2022 ; Tian et al, 2022 ), symptomatic intracerebral hemorrhage ( Lee et al, 2014 ; Chen et al, 2020 ; Song et al, 2020 ; Yuan et al, 2020 ; Bai et al, 2022 ; Cheng et al, 2022 ), and post-stroke depression ( Gu et al, 2015 ; Li et al, 2020 ). Follow-up intervals ranged from 14 days to 12 months for functional outcome and mortality, 36 h to 7 days for hemorrhagic transformation, 24 h to 7 days for symptomatic intracerebral hemorrhage, and 9 days to 3 months for post-stroke depression.…”

“…This could be due to the potential nonlinear relationship between serum uric acid levels and functional outcome in acute ischemic stroke, resulting in an optimal node for serum uric acid levels. Some recent studies have added evidence to the associations of uric acid with functional outcome ( Bai et al, 2022 ; Liu et al, 2022a , b ), mortality ( Bai et al, 2022 ; Liu et al, 2022a ), hemorrhagic transformation ( Cheng et al, 2022 ; Tian et al, 2022 ), and symptomatic intracerebral hemorrhage ( Bai et al, 2022 ; Cheng et al, 2022 ). Thus, this dose–response meta-analysis of cohort studies aimed to update and clarify the shape of the relationship between serum uric acid levels and prognosis in patients with acute ischemic stroke.…”

The Relationship between CT Angiography Collateral Score and Biochemical Parameters during Acute Ischemic Stroke Caused by Middle Cerebral Artery Infarct

“…Previous studies in the literature have shown that uric acid can have both positive and negative effects on the outcomes of AIS patients [27][28][29][30][31]. Liu et al [28] reported that extremely low or high uric acid levels have a negative effect on prognosis.…”

“…Previous studies in the literature have shown that uric acid can have both positive and negative effects on the outcomes of AIS patients [27][28][29][30][31]. Liu et al [28] reported that extremely low or high uric acid levels have a negative effect on prognosis. In their study, they emphasized that low levels of uric acid (<4.1 mg/dL) may lead to adverse clinical outcome and death among men, while high levels of uric acid (>6.6 mg/dL) may predict death among women.…”