Association between uric acid and the prognosis of acute ischemic stroke: A systematic review and meta-analysis

Mediators of the causal associations between protein ratios and ischemic stroke: a two-step Mendelian randomization study

BACKGROUND

Proteomics has revealed links between plasma proteins and ischemic stroke (IS), but the relationship between protein ratios, IS, and the effects of blood cells and serum uric acid (SUA) is underexplored.

METHODS

Using two-sample Mendelian randomization (MR), we assessed causal relationships between 2,821 protein ratios, 91 blood phenotypes, SUA, and IS subtypes. FDR correction was applied specifically to protein ratio analyses to account for multiple comparisons in the primary MR step. Significant associations were further validated through co-localization analysis, which assessed shared genetic architecture between exposure and outcome loci. This analysis used GWAS data from MEGASTROKE, GISCOME, minimizing confounding bias and reverse causation. Additionally, the total effects of protein ratio levels on IS were decomposed into direct and indirect effects mediated through multiple pathways. Sensitivity analyses ensured robustness.

RESULTS

The CD34/ITGAV ratio exhibited distinct effects on stroke risk, showing 34.9% increased odds of LAS (OR=1.349, 95% CI=1.097-1.658) while demonstrating protective effects against IS outcome progression (OR=0.564, 95% CI=0.380-0.838). Bayesian co-localization analysis revealed complete genetic overlap (PPH4 = 1) for key protein ratio-stroke subtype pairs: AIS with TGFBR2/THBD ratio, LAS with LGALS8/VWF ratio, CES with BST2/CEACAM1 and CD209/CLEC4G ratios. In mediation pathways, neutrophil parameters accounted for 54.4% of the prognosis effect in the ABHD14B/STAMBP-IS association, whereas SUA mediated only 1.3% of the PODXL2/SDC1 ratio-IS relationship.

CONCLUSIONS

Our MR study combined with co-localization analysis identifies causal links between protein interactions and IS, highlighting potential targets to disrupt pathways connecting protein ratio changes to IS incidence and outcomes, offering promising intervention avenues.

Association of serum uric acid to serum creatinine ratio with 1-year stroke outcomes in patients with acute ischemic stroke: A multicenter observational cohort study

BACKGROUND AND PURPOSE

Considering the reliance of serum uric acid (SUA) levels on renal clearance function, its role in stroke outcomes remains controversial. This study investigated the association of renal function-normalized SUA (SUA to serum creatinine ratio, SUA/SCr), a novel renal function index, with the 1-year outcomes in patients with acute ischemic stroke (AIS).

METHODS

This is a prospective, multicenter observational study. Renal function-normalized SUA levels were determined by calculating the ratio of SUA to SCr. One-year outcomes included stroke recurrence, all-cause mortality, and poor prognosis. Multivariable Cox regression analyses and restriction cubic splines for curve fitting were used to evaluate SUA/SCr's association with 1-year stroke outcomes.

RESULTS

Among 2294 enrolled patients, after adjustment for potential confounders, multivariable Cox regression analyses showed that each one-unit increase in SUA/SCr corresponded to a 19% decrease in 1-year stroke recurrence in patients with AIS. SUA/SCr was analyzed as a continuous variable and categorized into quartiles (Q1-Q4). Compared with the Q1 reference group, Q2, Q3, and Q4 showed significantly lower 1-year stroke recurrence risks. The trend test indicated significant differences in the 1-year stroke recurrence trend from Q1 to Q4. In these patients, SUA/SCr did not show a significant association with poor prognosis or all-cause mortality. Curve fitting revealed SUA/SCr had a negative but nonlinear association with 1-year stroke recurrence.

CONCLUSIONS

In patients with AIS, low SUA/SCr may be an independent risk factor for 1-year stroke recurrence. Changes in SUA/SCr had no significant impact on 1-year poor prognosis and all-cause mortality.

Association of Uric Acid, High-Sensitivity C-Reactive Protein, and 90-Day Risk of Poor Function Outcome in Patients with Ischemic Stroke or Transient Ischemic Attacks

Aim

The interaction between inflammatory biomarkers (high-sensitivity C-reactive protein, hsCRP) and antioxidants (uric acid, UA) regarding prognosis after ischemic stroke or transient ischemic attack (TIA) remains inadequately explored. This study aimed to assess (1) the individual and joint effects of hsCRP and UA, and (2) the neuroprotective role of UA in patients with elevated hsCRP levels concerning poor functional outcomes at 90 days.

Methods

A prospective cohort study was conducted involving 2140 consecutive ischemic stroke or TIA patients with hsCRP and UA levels. The primary outcome was defined as a poor functional outcome, indicated by a modified Rankin Scale (mRS) score of 3-6 at 90 days, with a shift in the mRS score as a secondary outcome. Logistic regression and propensity score (PS) analyses were employed to ensure robustness.

Results

Poor functional outcome occurred in 345 (16.1%) patients. Individual effects found that the highest quartiles of hsCRP (adjusted OR = 3.090; 95% CI 2.150-4.442) and UA (adjusted OR = 0.671; 95% CI 0.551-0.883) were associated with increased or decreased risk of poor functional outcome, respectively. Joint effects (adjusted OR = 3.994; 95% CI 2.758-5.640) between hsCRP and UA on the primary outcome were more apparent in patients with high hsCRP levels (hsCRP > 1.60 mg/L) and low UA levels (UA ≤ 291.85 µmol/L). For the patients with high hsCRP levels, patients with low UA levels had a higher risk of primary and secondary outcomes, compared with those with high UA levels, after unadjusted or adjusted for hsCRP. Similar and reliable results were observed in PS-based models.

Conclusion

In patients with ischemic stroke or TIA, joint high levels of hsCRP and low UA levels significantly correlate with increased risk of poor functional outcome at 90 days. In addition, high UA levels could reduce the risk of poor functional outcome for patients with high hsCRP levels.

Serum uric acid as a predictor of mortality in patients with stroke: results from National Health and Nutrition Examination Survey 2007-2016

Objective

This research endeavors to explore the relationship between serum uric acid (SUA) concentration and all-cause mortality in stroke patients.

Methods

We undertook a cross-sectional analysis utilizing data derived from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2016. The concentrations of SUA served as the independent variable, while the dependent variable was defined as all-cause mortality in stroke patients. The quartile method was utilized to classify uric acid levels into four distinct categories. Subsequently, three models were developed, and Cox proportional hazards regression was used to assess the effect of varying uric acid concentrations on the risk of all-cause mortality among stroke patients.

Results

The study included a total of 10,805 participants, of whom 395 were stroke patients. Among all populations, the group with elevated levels of uric acid (Q4) exhibited a significant association with the overall mortality risk among stroke patients in all three models (model 1 p < 0.001, model 2 p < 0.001, model 3 p < 0.001). In the male population, there was no significant correlation observed between uric acid levels and the overall mortality risk among stroke patients in model 3 (Q2 p = 0.8, Q3 p = 0.2, Q4 p = 0.2). However, within the female population, individuals with high uric acid levels (Q4) demonstrated a noteworthy association with the overall mortality risk among stroke patients across all three models (model 1 p < 0.001, model 2 p < 0.001, model 3 p < 0.001).

Conclusion

This cross-sectional investigation reveals a significant correlation between SUA levels and all-cause mortality in stroke patients, with a noticeable trend observed among females. Consequently, SUA may serve as a promising biomarker for assessing the prognosis of individuals affected by stroke.

Genetically predicted type 2 diabetes mellitus mediates the causal association between plasma uric acid and ischemic stroke

OBJECTIVE

This study conducts a systematic investigation into the causal relationships between plasma uric acid levels and subtypes of ischemic stroke (IS), as well as the extent to which Type 2 diabetes mellitus (T2DM) mediates this relationship.

BACKGROUND

There is a known association between Uric acid and IS but whether they have a causal relationship remains unclear. This study aims to determine whether a genetic predisposition to uric acid is causally linked to IS, including three subtypes, and to determine the mediating role of T2DM.

METHODS

Bidirectional Mendelian randomization (MR) analyses was initially used to explore the causal relationship between uric acid and three subtypes of IS. Two-step MR methods were then used to investigate the role of T2DM in mediating the effect of uric acid and IS with its subtypes.

RESULTS

A primary analysis showed uric acid had a markedly causal association with IS (IVW, OR 1.23; 95 % CI, 1.13 - 1.34; p = 6.39 × 10-9), and two subtypes of IS, Large-vessel atherosclerotic stroke LAS (IVW, OR 1.25; 95 % CI, 1.03 - 1.53; p = 0.026) and small vessel stroke (SVS) (IVW, OR 1.20; 95 % CI, 1.00 - 1.43; p = 0.049), but not with cardioembolic stroke (CES)(IVW, OR 1.00; 95 % CI, 0.87 - 1.15; p = 0.993). Two-step MR results showed that T2DM mediated the association between uric acid and LAS and SVS, accounting for 13.85 % (p = 0.025) and 13.57 % (p = 0.028), respectively.

CONCLUSIONS

The study suggests that genetic predisposition to uric acid is linked to a greater risk of IS, especially LAS and SVS. T2DM might mediate a significant proportion of the associations between uric acid and LAS as well as SVS.

The prognostic value of combined uric acid and neutrophil-to-lymphocyte ratio in acute ischemic stroke patients treated with intravenous thrombolysis

BACKGROUND

Serum uric acid (UA) and the neutrophil-to-lymphocyte ratio (NLR) have been reported to be associated with outcomes in acute ischemic stroke (AIS). However, whether UA is related to the prognosis of AIS patients undergoing intravenous thrombolysis (IVT) remains inconclusive. We sought to explore the combined effect of UA and NLR on the prognosis of AIS treated with IVT.

METHODS

A total of 555 AIS patients receiving IVT treatment were enrolled. Patients were categorized into four groups according to the levels of UA and NLR: LNNU (low NLR and normal UA), LNHU (low NLR and high UA), HNNU (high NLR and normal UA), and HNHU (high NLR and high UA). Multivariable logistic regression analysis was used to evaluate the value of serum UA level and NLR in predicting prognosis. The primary outcomes were major disability (modified Rankin scale (mRS) score 3-5) and death within 3 months.

RESULTS

After multivariate adjustment, a high NLR (≥ 3.94) increased the risk of 3-month death or major disability (OR, 2.23; 95% CI, 1.42 to 3.55, p < 0.001). However, there was no statistically significant association between a high UA level (≥ 313.00 µmol/L) and clinical outcome. HNHU was associated with a 5.09-fold increase in the risk of death (OR, 5.09; 95% CI, 1.31-19.83; P value = 0.019) and a 1.98-fold increase in the risk of major disability (OR, 1.98; 95% CI 1.07-3.68; P value = 0.030) in comparison to LNNU.

CONCLUSIONS

High serum UA levels combined with high NLR were independently associated with 3-month death and major disability in AIS patients after IVT.

Serum Uric Acid Levels and Outcome of Acute Ischemic Stroke: a Dose-Response Meta-analysis

Previous meta-analyses have reported conflicting results regarding the relationship between baseline uric acid (UA) levels and acute ischemic stroke (AIS) outcomes. Therefore, we conducted a dose-response meta-analysis to elucidate the association's strength and shape. Studies on the association between baseline UA levels and AIS outcomes in the PubMed and EMBASE databases were searched from their inception to April 17, 2023. Two researchers independently reviewed the studies for inclusion. A total of 23 articles involving 15,733 patients with AIS were included. The analysis revealed a significant inverse correlation between UA levels and AIS outcomes. The linear trend estimation indicated that a 50-μmol/L increment in UA level was associated with a 21.7% lower risk of hemorrhagic transformation (odds ratio [OR]: 0.783; 95% confidence interval [CI]: 0.743, 0.826; I2 = 43.4%; n = 4), 7.0% lower risk of 90-day unfavorable outcome [modified Rankin scale score ≥ 2] (OR: 0.930; 95% CI: 0.875, 0.990; I2 = 0%; n = 3), and 7.5% lower risk of 90-day poor outcome [modified Rankin scale score ≥ 3] (OR: 0.925; 95% CI: 0.863, 0.990; I2 = 74.4%; n = 3) in patients with AIS after accounting for relevant covariates. A linear dose-response relationship exists between baseline UA levels and the outcome of patients with AIS within a certain range, with higher baseline UA levels associated with better outcomes after AIS. Further dose-response meta-analyses, including a larger number of original articles, are required to validate our findings.

Exploring the Multifaceted Nexus of Uric Acid and Health: A Review of Recent Studies on Diverse Diseases

The prevalence of patients with hyperuricemia or gout is increasing worldwide. Hyperuricemia and gout are primarily attributed to genetic factors, along with lifestyle factors like consuming a purine-rich diet, alcohol and/or fructose intake, and physical activity. While numerous studies have reported various comorbidities linked to hyperuricemia or gout, the range of these associations is extensive. This review article focuses on the relationship between uric acid and thirteen specific domains: transporters, genetic factors, diet, lifestyle, gout, diabetes mellitus, metabolic syndrome, atherosclerosis, hypertension, kidney diseases, cardiovascular diseases, neurological diseases, and malignancies. The present article provides a comprehensive review of recent developments in these areas, compiled by experts from the Young Committee of the Japanese Society of Gout and Uric and Nucleic Acids. The consolidated summary serves to enhance the global comprehension of uric acid-related matters.

The Role of Uric Acid in Human Health: Insights from the Uricase Gene

Uric acid is the final product of purine metabolism and is converted to allantoin in most mammals via the uricase enzyme. The accumulation of loss of function mutations in the uricase gene rendered hominoids (apes and humans) to have higher urate concentrations compared to other mammals. The loss of human uricase activity may have allowed humans to survive environmental stressors, evolution bottlenecks, and life-threatening pathogens. While high urate levels may contribute to developing gout and cardiometabolic disorders such as hypertension and insulin resistance, low urate levels may increase the risk for neurodegenerative diseases. The double-edged sword effect of uric acid has resurrected a growing interest in urate's antioxidant role and the uricase enzyme's role in modulating the risk of obesity. Characterizing both the effect of uric acid levels and the uricase enzyme in different animal models may provide new insights into the potential therapeutic benefits of uric acid and novel uricase-based therapy.

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

Background

There have been contradictory findings regarding the relationship between serum uric acid levels and prognosis in acute ischemic stroke. Whether this association is nonlinear due to uric acid's paradoxical properties (antioxidant and prooxidant) is unclear.

Methods

We searched PubMed, Web of Science, and Embase databases until December 2022. Cohort studies reporting serum uric acid levels and functional outcome, mortality, or neurological complications in patients with acute ischemic stroke were included. Summary effect estimates were calculated using a random-effect model. Moreover, dose-response relationships were assessed by the generalized least squares trend estimation.

Results

Altogether, 13 cohort studies were identified in this study. Compared to the lowest baseline serum uric acid levels, the highest levels were associated with decreased risk of poor functional outcome (OR = 0.70, 95% CI 0.54-0.91, I2 = 29%), hemorrhagic transformation (OR = 0.15, 95% CI 0.05-0.42, I2 = 79%), and post-stroke depression (OR = 0.04, 95% CI 0.00-0.95, I2 = 89%), but not associated with mortality and symptomatic intracerebral hemorrhage. A nonlinear relationship was observed in poor functional outcome (U-shaped, P for nonlinearity = 0.042), hemorrhagic transformation (inverse, P for nonlinearity = 0.001), and post-stroke depression (inverse, P for nonlinearity = 0.002). In addition, there was a single study reporting a U-shaped association in post-stroke epilepsy (P for nonlinearity <0.001). Furthermore, another study reported a positive curvilinear association in stroke recurrence (P for nonlinearity <0.05). The insufficient number of original articles for some prognostic indicators should be considered when interpreting the results of this meta-analysis.

Conclusion

In patients with acute ischemic stroke, serum uric acid levels are nonlinearly associated with the risk of poor functional outcome (U-shaped). More evidence is needed to confirm the association between serum uric acid levels and neurological complications following acute ischemic stroke.

Uric acid and neurological disease: a narrative review

Hyperuricemia often accompanies hypertension, diabetes, dyslipidemia, metabolic syndrome, and chronic renal disease; it is also closely related to cardiovascular disease. Moreover, several epidemiological studies have linked hyperuricemia and ischemic stroke. However, uric acid may also have neuroprotective effects because of its antioxidant properties. An association between low uric acid levels and neurodegenerative diseases has been suggested, which may be attributed to diminished neuroprotective effects as a result of reduced uric acid. This review will focus on the relationship between uric acid and various neurological diseases including stroke, neuroimmune diseases, and neurodegenerative diseases. When considering both the risk and pathogenesis of neurological diseases, it is important to consider the conflicting dual nature of uric acid as both a vascular risk factor and a neuroprotective factor. This dual nature of uric acid is important because it may help to elucidate the biological role of uric acid in various neurological diseases and provide new insights into the etiology and treatment of these diseases.

Postoperative Hyperuricemia-A Risk Factor in Elective Cardiosurgical Patients

Hyperuricemia is a well-known cardiovascular risk factor. The aim of our study was to investigate the connection between postoperative hyperuricemia and poor outcomes after elective cardiac surgery compared to patients without postoperative hyperuricemia. In this retrospective study, a total of 227 patients after elective cardiac surgery were divided into two groups: 42 patients with postoperative hyperuricemia (mean age 65.14 ± 8.9 years) and a second group of 185 patients without it (mean age 62.67 ± 7.45 years). The time spent on mechanical ventilation (hours) and in the intensive care unit (days) were taken as the primary outcome measures while the secondary measure comprised postoperative complications. The preoperative patient characteristics were similar. Most of the patients were men. The EuroSCORE value of assessing the risk was not different between the groups nor the comorbidities. Among the most common comorbidities was hypertension, seen in 66% of all patients (69% in patients with postoperative hyperuricemia and 63.7% in those without it). A group of patients with postoperative hyperuricemia had a prolonged time of treatment in the intensive care unit (p = 0.03), as well as a prolonged duration of mechanical ventilation (p < 0.01) and a significantly higher incidence of the following postoperative complications: circulatory instability and/or low cardiac output syndrome (LCOS) (χ2 = 4486, p < 0.01), renal failure and/or continuous venovenous hemodiafiltration (CVVHDF's) (χ2 = 10,241, p < 0.001), and mortality (χ2 = 5.22, p < 0.01). Compared to patients without postoperative hyperuricemia, elective cardiac patients with postoperative hyperuricemia have prolonged postoperative treatment in intensive care units, extended durations of mechanically assisted ventilation, and a higher incidence of postoperative circulatory instability, renal failure, and death.

Serum uric acid to serum creatinine ratio predicts neurological deterioration in branch atheromatous disease

Background and objective

Branch atheromatous disease (BAD) makes patients prone to early neurological deterioration (END), resulting in poor prognosis. The aim of this study was to investigate the association between SUA/SCr and END in BAD stroke patients.

Methods

We conducted a retrospective study that included 241 patients with BAD-stroke within 48 h of symptom onset. We divided the patients into the END group and the no END group. END was defined as an NIHSS score increase of more than 2 points within 1 week. SUA/SCr was calculated by the concentration of serum uric acid and creatine (serum uric acid/serum creatine) on admission. Univariate and multivariate analyses were used to identify independent predictors of END in BAD-stroke patients.

Results

END was observed in 24.1% (58/241) of the patients in our study. Multiple logistic regression analyses showed that SUA/SCr (aOR, 0.716; 95% CI, 0.538-0.952; P = 0.022) and female sex (aOR, 0.469; 95% CI, 0.245-0.898; P = 0.022) were associated with END after adjusting for confounding factors. The predicted value of SUA/Scr for END was a sensitivity of 79.3%, a specificity of 44.8%, and an AUC of 0.609 (95% CI, 0.527-0.691, P < 0.05). The optimal cut-off value was 4.76.

Conclusion

SUA/SCr was negatively associated with the risk of END in BAD stroke patients.

Association between serum uric acid to serum creatinine ratio and poor functional outcomes in patients with acute ischemic stroke

BACKGROUND

The role of serum uric acid (SUA) in prognosis is controversial because SUA levels largely depend on renal clearance function. This study aimed to investigate the association between renal function-normalized SUA (SUA to serum creatinine ratio, SUA/SCr) and poor functional outcomes in patients with acute ischemic stroke (AIS).

METHODS

All patients were recruited from the Third China National Stroke Registry. Poor functional outcomes were defined by modified Rankin Scale (mRS) scores of 3-6 at 3 months or 2-6 at 1 year.

RESULTS

Among 8169 enrolled patients, the median SUA/SCr was 4.19 (interquartile range, 3.47-5.08). Compared with patients in the fourth quintile group, those in the first quintile group had higher proportions of mRS score 3-6 (odds ratio [OR] 1.55; 95% confidence interval [CI] 1.24-1.93) and mRS score 2-6 (OR 1.28; 95% CI 1.08-1.53) at 3 months. The addition of SUA/SCr to the conventional risk model had a greater incremental value than the addition of SUA or SCr alone. Subgroup analysis showed that the association was only significant in patients with normal kidney function (P for interaction<0.05). Similar results were found for outcomes at 1 year.

CONCLUSIONS

A lower level of SUA/SCr was associated with poor functional outcomes in patients with AIS at 3 months and at 1 year, suggesting the potential use of SUA/SCr in clinical practice as a preferable marker for stroke outcomes.

Chinese version of the auditory verbal learning test: normative study and clinical applications in Chinese-speaking population in Shijiazhuang city

OBJECTIVE

The purposes were to establish standardized values for the Auditory Verbal Learning Test (AVLT) in the communities of Shijiazhuang city (China), with particular focus on the influences of age, education and sex, and to detect the discriminant validity data of the AVLT in patients with acute ischemic stroke (AIS).

METHODS

406 Chinese-speaking subjects (age: 50-84 years old) from Shijiazhuang city, were brought into this study. Using linear regression analyses, standardized values were developed for three variables of interest, including scores on short-term memory (sum of AVLT trials 1-3), delayed recall (AVLT trial 4), and an index representing recognition memory corrected for false-positive identifications (AVLT trial 5). 177 patients with AIS were included to probe the discriminant validity of the AVLT.

RESULTS

The linear regression analysis showed statistically significant effect of age and sex on all trials of the AVLT. Years of education contributed significantly to trial 1-3 and trial 4 but not trial 5. Based on the results obtained, trail 1-3 and trail 4 of AVLT norms were stratified by age (3 strata), education (2 strata), and sex (2 strata). Trail 5 norms were stratified by age (3 strata) and sex (2 strata). Moreover, AIS groups performed significantly worse on most AVLT trials than matched cognitively healthy controls.

CONCLUSIONS

Normative data stratified by age, education and sex for the Chinese-speaking community-residents in Shijiazhuang was presented for use in research and clinical settings. The AVLT measures adequately differentiated between the cognitive performance (especially memory decline) of healthy adults and patients with AIS.

Uric Acid and Cognitive Impairment in Patients with Acute Ischemic Stroke: A Meta-Analysis

Serum uric acid (UA) has been suggested to be correlated with outcomes after stroke. We performed a meta-analysis to evaluate the association between serum UA and post-stroke cognitive impairment (PSCI) in patients with acute ischemic stroke (AIS). Relevant observational studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. Overall, eleven studies with 4246 patients of AIS were included, 2073 (48.8%) of them had PSCI. Pooled results showed that patients with PSCI had significantly higher level of serum UA as compared to those without PSCI (mean difference: 35.70 μmol/l, 95% confidence interval (CI): 8.36 to 63.01, p=0.01; I2=95%). Subgroup analysis showed significant higher level of serum UA in patients with PSCI evaluated during follow-up of 3 months to 3 years, but not for those evaluated during hospitalization (p for subgroup difference=0.01). In addition, results of meta-analysis also showed that compared to patients with lower serum UA, AIS patients with higher serum UA had increased risk of PSCI (odds ratio: 1.33, 95% CI: 1.02 to 1.73, p=0.04; I2=72%). Higher level of serum UA after disease onset may be a marker of increased risk of PSCI in patients with AIS. Although these findings need to be validated in large-scale prospective studies, the possible mechanisms underlying the association between UA and PSCI should be also investigated.

U-Shaped Association Between Serum Uric Acid and Hemorrhagic Transformation After Intravenous Thrombolysis

BACKGROUND

Uric acid (UA) has both antioxidative and pro-oxidative properties. The study aimed to investigate the relationship between serum UA and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke.

METHODS

The patients undergoing intravenous thrombolysis from two hospitals in China were retrospectively analyzed. HT was evaluated using computed tomography images reviewed within 24- 36h after thrombolysis. Symptomatic intracranial hemorrhage (sICH) was defined as HT accompanied by worsening neurological function. Multivariate logistic regression and spline regression models were performed to explore the relationship between serum UA levels and the risk of HT and sICH.

RESULTS

Among 503 included patients, 60 (11.9%) were diagnosed with HT and 22 (4.4%) developed sICH. Patients with HT had significant lower serum UA levels than those without HT (245 [214-325 vs. 312 [256-370] μmol/L, p < 0.001). Multivariable logistic regression analysis indicated that patients with higher serum UA levels had a lower risk of HT (OR per 10-μmol/L increase 0.96, 95%CI 0.92-0.99, p = 0.015). Furthermore, multiple-adjusted spline regression models showed a Ushaped association between serum UA levels and HT (p < 0.001 for non-linearity). Similar results were present between serum UA and sICH. Restricted cubic spline models predicted the lowest risk of HT and sICH when the serum UA levels were 386μmol/L.

CONCLUSION

The data show the U-shaped relationship between serum UA levels and the risk of HT and sICH after intravenous thrombolysis.