Lower uric acid level may be associated with hemorrhagic transformation after intravenous thrombolysis

Tian, Yuxuan; Xie, Qianqian; You, Jiulin; Yang, Shaonan; Zhao, Hongqin; Song, Yuqiang

doi:10.1007/s10072-021-05760-8

Cited by 11 publications

(20 citation statements)

References 28 publications

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“…Uric acid, one of the most important endogenous antioxidants, is the final product of purine metabolism that plays a neuroprotective role by scavenging free radicals, inhibiting neuroinflammatory cascades, and reducing the blood-brain barrier permeability ( 20 – 22 ). Previous studies indicated that a lower uric acid level was independently associated with a high risk of HT after intravenous thrombolysis ( 23 , 24 ). Our study also found that lower uric acid could increase the risk of HT after intravenous thrombolysis.…”

Section: Discussionmentioning

confidence: 91%

A novel nomogram to predict hemorrhagic transformation in ischemic stroke patients after intravenous thrombolysis

Yang

Zhong²,

Zou³

et al. 2022

Front. Neurol.

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BackgroundHemorrhagic transformation (HT) is the most serious complication of ischemic stroke patients after intravenous thrombolysis and leads to a poor clinical prognosis. This study aimed to determine the independent predictors associated with HT in stroke patients with intravenous thrombolysis and to establish and validate a nomogram that combines with predictors to predict the probability of HT after intravenous thrombolysis in patients with ischemic stroke.MethodThis study enrolled ischemic stroke patients with intravenous thrombolysis from December 2016 to June 2022. All the patients were divided into training and validation cohorts. The nomogram was composed of the significant predictors for HT in the training cohort as obtained by the multivariate logistic regression analysis. The area under the receiver operating characteristic curve was used to assess the discriminative performance of the nomogram. The calibration performance of the nomogram was assessed by the Hosmer–Lemeshow goodness-of-fit test and calibration plots. Decision curve analysis was used to test the clinical validity of the nomogram.ResultsA total of 394 patients with intravenous thrombolysis were enrolled in the study. In the training cohort (n = 257), 45 patients had HT after intravenous thrombolysis. Multivariate logistic regression analysis demonstrated early infarct signs (OR, 7.954; 95% CI, 3.553-17.803; P < 0.001), NIHSS scores (OR, 1.110; 95% CI, 1.054-1.168; P < 0.001), uric acid (OR, 0.993; 95% CI, 0.989–0.997; P = 0.001), and albumin-to-globulin ratio (OR, 0.109; 95% CI, 0.023–0.508; P = 0.005) were independent predictors for HT and constructed the nomogram. In the training and validation cohorts, the AUC of the nomogram was 0.859 and 0.839, respectively. The Hosmer–Lemeshow goodness-of-fit test and calibration plot showed good concordance between predicted and observed probability in the training and validation cohorts. Decision curve analysis indicated that the nomogram was significantly useful for predicting HT in the training and further confirmed in the validation cohort.ConclusionThis study proposes a novel and practical nomogram based on early infarct signs, NIHSS scores, uric acid, and albumin-to-globulin ratio that can well predict the probability of HT after intravenous thrombolysis in patients with ischemic stroke.

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Section: Discussionmentioning

confidence: 91%

A novel nomogram to predict hemorrhagic transformation in ischemic stroke patients after intravenous thrombolysis

Yang

Zhong²,

Zou³

et al. 2022

Front. Neurol.

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“… 11 , 30 It also demonstrated that lower UA levels predicted a higher risk of hemorrhagic transformation after ischemic stroke. 12 , 31 Chamorro et al demonstrated a 12% increase in the odds of a good clinical outcome for each milligram per deciliter increase of serum UA among patients with AIS. 32 Furthermore, analysis of the URICO-ICTUS trial further reported that UA combined with alteplase may prevent early stroke progression.…”

Section: Discussionmentioning

confidence: 99%

Uric Acid and Clinical Outcomes in Young Patients with Ischemic Stroke

Liu¹,

Liu²,

Jia³

et al. 2022

NDT

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Background and Purpose There is limited available evidence for the relationship between uric acid (UA) levels and ischemic stroke in young adults. We aimed to explore the association between UA levels and acute ischemic stroke (AIS) in young patients. Materials and Methods This was a prospective and observational study. We recruited young patients aged 18–45 years with AIS at our tertiary hospital. Patients were categorized into four groups according to quartiles of UA levels. The primary outcome was functional outcome at 3 months. The secondary outcomes included stroke severity, in-hospital complications, and functional outcome at discharge. Modified Rankin Scale (mRS) scores were used to assess functional outcome as poor (mRS=2-6) or favorable(mRS=0-1). Results A total of 636 patients were enrolled in the current analysis. The four groups were defined as follows: Q1≤289.8 µmol/L, 289.8 µmol/ L421 µmol/L. Multiple logistic regression analysis showed that UA levels were not significantly predictive of functional outcome either at discharge or at 3 months after AIS. However, compared to Q1, higher UA levels were significantly negatively associated with the rate of moderate-severe stroke (NIHSS≥5) at admission (p for trend =0.016). Furthermore, a reduction in the risk for in-hospital pneumonia was significantly associated with higher UA levels compared to Q1 ( P for trend < 0.0001). Conclusion Serum UA was a protective factor for stroke severity and in-hospital pneumonia after AIS in young patients. However, we were unable to identify the predictive significance of UA for functional outcome either at discharge or at 3 months after AIS.

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“…The subjects were 4708 patients with AIS, including 721 patients with HT and 3987 patients without HT. In these articles, the interventions involved were IVT (n = 7) 16,26,28,[30][31][32][33] and EVT (n = 4) 24,25,27,29 , respectively, and one of them did not limit IVT or EVT 3 . There were 8 articles believed that patients without HT had significantly higher UA degrees compared to those with HT 3,16,[26][27][28][30][31][32] .…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In these articles, the interventions involved were IVT (n = 7) 16,26,28,[30][31][32][33] and EVT (n = 4) 24,25,27,29 , respectively, and one of them did not limit IVT or EVT 3 . There were 8 articles believed that patients without HT had significantly higher UA degrees compared to those with HT 3,16,[26][27][28][30][31][32] . Several articles have enriched this conclusion: one of the articles 16 clearly stated that no matter what types of HT, the UA degrees were lower than that of the non-HT group; another article 26 drew the further conclusion that lower UA degrees were an independent risk factor for HT in large artery atherosclerosis stroke (LAA) patients or cardioembolism (CE) patients; and another paper 16 indicated that ascending UA degrees may bring good outcomes compared to poor outcomes in AIS patients (345.67 ± 103.55 vs. 336.95 ± 95.5 μmol/L, P = 0.509).…”

Section: Study Characteristicsmentioning

confidence: 99%

Association Between Uric Acid and Hemorrhagic Transformation: A Systematic Review and Meta-Analysis

Qian,

Li,

et al. 2023

Preprint

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BackgroundThe relationship between uric acid (UA) and hemorrhagic transformation (HT) remained controversial. The purpose of this study was to investigate the relationship between UA degrees and the risk of HT after acute ischemic stroke (AIS).Methods and methodsElectronic databases were sought for studies on UA and HT from inception to October 31, 2023. Two researchers independently reviewed the studies for inclusion. STATA Software 16.0 was used to compute the standardized mean difference (SMD) and 95% confidence interval (CI) of the pooled and post-outlier outcomes. The heterogeneity was evaluated using the I2statistic and the Galbraith plot, and sensitivity analysis was also performed. Begg’s funnel plot and Egger’s test were used to assess publication bias.Results12 trials were included in the meta-analysis, with a total of 4,708 individuals. Low UA degrees were linked to higher HT post-AIS patients following the pooled SMDs’ forest plot (SMD = -0.34, 95% CI = -0.60–0.08,P= 0.010). The high heterogeneity (I2= 89.0%,P<0.001) was found in the studies. Six papers were outside the Galbraith plot regression line and there was no heterogeneity when they were excluded (I2= 45.8%,P= 0.100). Meanwhile, the repeated SMDs (SMD = -0.487, 95% CI = -0.632–0.342,P= 0.000) still meant that the HT group had lower UA degrees. There was no publication bias in our meta-analysis following Begg’s funnel plot or Egger’s test.ConclusionsThe meta-analysis illustrated a substantial positive connection between UA degrees and HT, with lower UA separately linked with higher HT post-AIS. It provided a certain theoretical basis for the later related research.

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Lower uric acid level may be associated with hemorrhagic transformation after intravenous thrombolysis

Cited by 11 publications

References 28 publications

A novel nomogram to predict hemorrhagic transformation in ischemic stroke patients after intravenous thrombolysis

A novel nomogram to predict hemorrhagic transformation in ischemic stroke patients after intravenous thrombolysis

Uric Acid and Clinical Outcomes in Young Patients with Ischemic Stroke

Association Between Uric Acid and Hemorrhagic Transformation: A Systematic Review and Meta-Analysis

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