Abstract
BackgroundConflicting results on the correlation between hyperuricemia and the prognosis of stroke had been reported and the close association between serum uric acid (SUA) and abnormal glycomatabolism might further complicate the assessment of the correlation. We aimed to investigate SUA in predicting the prognosis of acute stroke in different glycometabolism status.MethodsA total of 2907 patients aged from 18 to 85 (1220 diabetes mellitus (DM), 777 prediabetes and 910 normoglycemia) were selected from the Abnormal Glucose Regulation in Patients with Acute Stroke across China (ACROSS-China) study. The patients were divided into groups according to the SUA quartile as well as decile. The correlations between SUA and the poor outcome (mRS > 2) at discharge were assessed stratified by glucose metabolism status. Multivariate logistic regression was used to analyze the potential risk factors of poor in-hospital outcome of stroke and the risk-adjustment of the correlation between SUA and the prognosis of stroke. P < 0.05 was considered statistically significant.ResultsSUA were divided first as Quartile1 to 4 (Quartile1 < 221 μmol L−1; Quartile2 (221–286) μmol L−1; Quartile3 (286–352) μmol L−1 and Quartile4 > 352 μmol L−1), then as decile1 to 10. In normoglycaemia, SUA quartiles, deciles and continuous SUA concentration were independently significantly associated with poor outcome. Q1 was independently associated with the higher possibility of poor functional outcome (compared to Q4, odds ratios (ORs) with 95% confidential interval (CI) was 3.79 (1.23–8.67) in Q1); Lower level of SUA in DM was also associated with poor functional outcome at discharge compared to the highest level of SUA(Q4)(OR with 95% CI, 2.07 (1.05–4.08)), however, lower SUA level was also related to severer stroke at admission in DM as well as in prediabetes (P < 0.001 in DM and 0.023 in prediabetes) and severer stroke resulted in worse functional outcome at discharge (OR with 95% CI, 12.15 (8.08–18.21) in DM and 11.58 (7.50–23.25) in prediabetes). But in normoglycamic stroke, SUA levels did not differ in stroke severity at admission (P = 0.066).ConclusionsLow SUA level (<221 μmol L−1) independently and strongly predicts the short-term poor functional outcome in acute stroke with normoglycaemia other than diabetes or prediabetes.
Highlights
Conflicting results on the correlation between hyperuricemia and the prognosis of stroke had been reported and the close association between serum uric acid (SUA) and abnormal glycomatabolism might further complicate the assessment of the correlation
Patient selection ACROSS-CHINA” was a large prospective cohort study conducted in China from 2008 to 2009 that investigated on abnormal glucose regulation in acute first-ever stroke, in which a total of 3450 patients with ischemic stroke, intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were successively recruited from 34 hospitals across China [19, 20]
The associations between post-stroke SUA and poor functional outcome at discharge differ in diverse abnormal glycometabolism populations
Summary
Conflicting results on the correlation between hyperuricemia and the prognosis of stroke had been reported and the close association between serum uric acid (SUA) and abnormal glycomatabolism might further complicate the assessment of the correlation. Conflicting results on the correlation between hyperuricemia and the incidence and prognosis of stroke had been reported. Other study suggested that the effect of prestroke hyperuricemia on poor post-stroke outcome, especially in diabetic patients, was still questionable [5]. Holme and his group suggested that hyperuricemia might be rather a complementary indicator than an independent risk factor of AS [6]. Miedema et al found no evidence to support the association between the SUA level and the outcome of stroke in their study [13]
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