Prognostic Significance of Uric Acid Levels in Ischemic Stroke Patients

Abstract

The importance and function of serum uric acid (UA) levels in patients with cardiovascular disease or stroke are unclear. We sought to evaluate the appropriate UA levels for stroke patients and the association between endogenous UA levels and clinical outcomes in acute ischemic stroke (AIS) patients, particularly regarding the possible interaction between gender and UA levels with respect to AIS prognosis. We examined 303 patients who had an onset of ischemic stroke within 48 h. Of those, 101 patients received thrombolytic treatment. Serum UA (μmol/L) levels were measured the second morning after admission. Patient prognosis was evaluated 90 days after clinical onset by modified Rankin Scale. Patients were divided into four groups according to serum UA quartiles. A binary multivariate logistic regression model was used to assess clinical relevance in regard to functional outcome and endogenous UA levels. Analysis of subgroups by gender and normal glomerular filtration rate were also been done. Poor functional outcome was associated with older age, history of atrial fibrillation, or higher baseline National Institutes of Health Stroke Scale scores. After adjustment for potential confounders, patients with higher UA levels (>380 μmol/L) or lower UA levels (≤250 μmol/L) were 2-3 times more likely to have a poor outcome (OR 2.95, 95% CI 1.14-7.61; OR 2.78, 95% CI 1.02-7.58, respectively) compared to the baseline group (UA level 316-380 μmol/L). The same results were observed in thrombolyzed patients. Patients with high and low UA levels were 9-18 times more likely to having poor outcomes compared to the baseline group (UA level: 316-380 μmol/L; OR 18.50, 95% CI: 2.041-167.67; OR 9.66, 95% CI 1.42-65.88, respectively). In men, patients with high UA levels were 6 times more likely to have poor outcomes compared to the baseline group (UA level: 279-334 μmol/L; OR 6.10, 95% CI 1.62-22.93). However, female patients with UA level 271-337 μmol/L were seven times more likely to perform badly compared to the baseline group (UA level >337 μmol/L, OR 7.06, 95% CI 1.00-49.81). Serum UA levels in an appropriate range were associated with better outcome in patients with AIS but may be harmful when too high or too low. The association of UA levels with AIS prognosis differed in male and female patients, which highlights the necessity of stratifying by gender in investigations of cerebrovascular risk factors.

Sex-specific Association Between Uric Acid and Outcomes After Acute Ischemic Stroke: A Prospective Study from CATIS Trial

“…However, the results of epidemiological studies investigating the effect of serum UA levels on the prognosis of acute ischemic stroke are conflicting because of previous studies being limited to small single-center series or poor study design. Some studies suggested serum UA was protective for the prognosis of acute ischemic stroke10111213, whereas others indicated that it had no such effect1415 or even increased the risk of poor outcome and future vascular events after acute stroke1617. It is well known that UA levels are higher in men, and a sex-difference in the relationship between serum UA and risk of cardiovascular disease had been reported181920.…”

How to Design Economic Predictive Laboratory Panel Evaluating Acute Ischemic Stroke Outcome

“…Prolonged aPTT was associated with worse stroke outcome, suggesting it's neuro-protective effect at short time (Kisialioul et al, 2012) [29]. But the INR values in this study were not significantly associated with SSS or MRS, so INR can't be considered in the evaluation of AIS patients of this study, but it is more useful in monitoring thrombolytic therapy to avoid serious cerebral hemorrhage this opinion is in day 90 and smaller infarct volume [18] [36]. In this study we noticed that, the elevated SUA was associated with less severe stroke and better outcome, so high SUA may be an independent predictor of AIS [17] [37].…”

“…Another chemical investigation within the predictive panels of AIS is SUA. Its high level is associated with excellent outcomes so it used as adjuvant therapy to thrombolysis [17] [18]. Serum TG is an independent predictor of AIS outcome, but its association with cardio-embolic stroke is not a role [19].…”

Low uric acid level increases the risk of infectious mononucleosis and this effect is more pronounced in women

“…In the clinical setting, higher levels of UA have been associated with gout (24,25), and associations between hyperuricemia and an increased risk of various metabolic disorders have also been described (5,6). In fact, a U-shaped association between extremely low or high UA levels and worse outcome has been described in stroke (10,26). However, it appears that, under conditions of increased oxidative stress, as occurs in acute ischemic stroke, the balance between anti-and pro-oxidant properties shifts to promote neuroprotection (27)(28)(29)(30).…”

“…Abnormalities in the serum levels of UA have been observed in several diseases. For example, a low UA level has been detected in stroke (8)(9)(10), multiple sclerosis (MS) (11,12), infections of the central nervous system (CNS) (13,14) and leprosy reaction episodes (15). As regards IM, the number of previous related studies is limited and the results are conflicting.…”