Serum uric acid levels and outcome during admission in acute ischaemic stroke, depending on renal function

Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana; Robles, Nicolás Roberto

doi:10.1080/00207454.2018.1441150

Cited by 10 publications

(6 citation statements)

References 33 publications

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“…We deemed that the SUA/Cr ratio would be more sensitive in predicting POD in older patients following urinary calculi surgery, which might be a result of eliminating the effect of renal function on UA. 40 Similar to our research, prior studies demonstrated the SUA/Cr level in patients with Parkinson’s disease (PD) was lower and was negatively associated with the stages of PD. 41 , 42 Nevertheless, other studies indicated the high SUA/Cr ratio could result in poorer functions outcomes and the increased risk of stroke recurrence after ischemic stroke, which might be explained by the controversial role of UA and its physiological metabolism.…”

Section: Discussionsupporting

confidence: 89%

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

Liu

Gao

et al. 2023

CIA

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Purpose This study was to investigate the incidence and potential predictive factors for postoperative delirium (POD) in older people following urinary calculi surgery, and to establish the corresponding risk stratification score by the significant factors to predict the risk of POD. Patients and Methods We retrospectively analyzed the perioperative data of 195 patients aged 65 or older who underwent elective urinary calculi surgery between September 2020 and September 2022. POD was defined by chart-based method, and the serum uric acid to creatinine (SUA/Cr) ratio as well as neutrophil-to-lymphocyte ratio (NLR) were calculated, respectively. Identification of the risk factors for POD was performed by univariate and multivariate logistic regression analysis. Moreover, the risk stratification score was developed based on the regression coefficients of the associated variables. Results In 195 eligible patients following urinary calculi surgery, the median age was 69 (66–72) and 19 patients ultimately developed POD (9.7%). The results by univariate analysis showed that patients with advanced age, high American Society of Anesthesiologists (ASA) physical status (≥3) and low SUA/Cr ratio (≤3.3) were more likely to develop POD, but dexmedetomidine can significantly decrease the risk of the occurrence of POD. The multivariate analysis further indicated that high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were independently associated with POD, and the POD incidence could obviously be elevated with the increase of risk stratification score. Moreover, patients with delirium had longer hospital stays. Conclusion POD is frequent in geriatric patients following urinary calculi surgery (9.7%). The high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were effective predictors of POD. The corresponding risk stratification based on these factors could be beneficial to determining patients who are susceptible to POD, and thus better preventing and reducing the occurrence of POD. However, large prospective studies are needed to confirm this finding.

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Section: Discussionsupporting

confidence: 89%

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

Liu

Gao

et al. 2023

CIA

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“…Chiquete et al [ 16 ] posited that the correlation between low concentration of UA and severity of acute cerebral infarction could be used as a marker of the degree of cerebral infarction. According to Arevalo-Lorido et al [ 17 ], NIHSS scores decrease with increasing UA, even in patients with cerebral infarction and abnormal renal function. In performing a randomized, double-blind, placebo-controlled phase 2b/3 trial in which UA was added during thrombolytic therapy administered to patients with acute cerebral infarction, Chamorro et al [ 18 ] found that UA had a protective effect on the patient's nerve function.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Uric Acid Level and Severity of Acute Primary Cerebral Infarction: A Cross-Sectional Study

Ru-ying

Zhong

Zhou

et al. 2020

BioMed Research International

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Numerous studies have shown that uric acid (UA) is associated with cerebrovascular disease, but whether UA is a protective factor or worsens the risk of developing cerebrovascular disease remains controversial. This study investigated the relationship between UA levels detected at admission and the severity of acute primary cerebral infarction. This cross-sectional study enrolled patients with acute primary cerebral infarction (N=238, 157 men). We designated the levels of serum UA measured at the time of admission as the independent variable and the degree of neurological impairment at admission as the dependent variable. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the extent of neurological dysfunction: NIHSS≤5, minor stroke; NIHSS>5, moderate to severe stroke. There was a statistically significant difference in UA levels between patients with mild cerebral infarctions (NIHSS≤5) and those with moderate or severe cerebral infarctions (NIHSS>5) (P<0.0001). After adjusting for confounding factors, the serum UA level was found to be nonlinearly related to NIHSS, and the inflection point was 372 μmol/L. The extent of the influence and confidence interval was 0.99 (0.98, 0.99) on the left side of the inflection point and 1.00 (1.00, 1.01) on the right side. There was a nonlinear relationship between the UA level measured on admission and the degree of neurological impairment in patients with acute primary cerebral infarction. When UA was <372 μmol/L, it was negatively correlated with the degree of neurological impairment in patients with acute cerebral infarction, but when UA was ≥372 μmol/L, the protective effect of UA disappeared.

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“…In contrast, rats receiving intraperitoneal UA infusions presented with antihypertensive and nephroprotective effects, probably due to the antioxidant effects of UA 9–11 . A protective role for UA during acute ischaemic stroke has also been reported 12–15 …”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] A protective role for UA during acute ischaemic stroke has also been reported. [12][13][14][15] In the absence of previous renal impairment, harmful hyperuricaemia-associated morphological changes have been reported in rat kidneys. 5,[16][17][18] A diet with 2% of the uricase inhibitor Oxo was found to increase collagen deposition, macrophage infiltration, juxtaglomerular renin staining and media-lumen ratio of afferent arterioles and induce glomerular hypertrophy in rat kidneys.…”

Section: Introductionmentioning

confidence: 99%

Moderate hyperuricaemia ameliorated kidney damage in a low‐renin model of experimental renal insufficiency

Kurra

Eräranta

Paavonen

et al. 2022

Basic Clin Pharma Tox

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Background: Hyperuricemia may predispose to renal damage, but in end-stage renal disease lower uric acid concentrations have been associated with higher mortality. In experimental studies, uric acid has promoted renal brosis and in ammation, but some studies have shown nephroprotective effects probably due to alleviated oxidative stress. We studied the in uence of moderate hyperuricemia on kidney morphology in 5/6 nephrectomized rats.Methods: Three weeks after subtotal nephrectomy or sham-operation, rats were put on 2.0% oxonic acid (uricase inhibitor) diet for 9 weeks. Blood pressure was monitored using tail-cuff. At close of the study, blood, urine, and kidney samples were taken, and renal histology, mast cell count, and oxidative stress markers were determined. Kidney tissue in ammation and brosis were evaluated using RT-PCR and immunohistochemistry.Results: Oxonic acid diet increased plasma uric acid levels by >80 µmol/l without in uencing blood pressure. Creatinine clearance was reduced by ~60% in both remnant kidney groups, and by ~30% in hyperuricemic sham-operated rats. In remnant kidney rats with suppressed plasma renin activity, moderate hyperuricemia decreased glomerulosclerosis, tubulointerstitial damage, and kidney mast cell count, but did not in uence the brosis marker collagen I mRNA content. In both hyperuricemic groups, the mast-cell product 11-epi-prostaglandin-F 2α excretion to the urine and kidney tissue COX-2 levels were decreased.Conclusions: Hyperuricemic remnant kidney rats displayed improved kidney morphology and reduced markers of oxidative stress and in ammation. Thus, moderately increased plasma uric acid had bene cial effects on the kidney in this low-renin model of experimental chronic renal insu ciency.

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Serum uric acid levels and outcome during admission in acute ischaemic stroke, depending on renal function

Abstract: Our results support the hypothesis that hyperuricaemia plays a protective role in the prognosis of stroke, independently from renal function, and that even in patients with chronic kidney disease, it remains as a protective agent.

Cited by 10 publications

References 33 publications

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

Relationship between Uric Acid Level and Severity of Acute Primary Cerebral Infarction: A Cross-Sectional Study

Moderate hyperuricaemia ameliorated kidney damage in a low‐renin model of experimental renal insufficiency

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