Prognostic significance of uric acid change in acute ischemic stroke patients with reperfusion therapy.

Abstract

Uric acid (UA) is an important endogenous free radical scavenger that has been found to have a neuroprotective effect. However, there is uncertainty about the relationship between UA change and outcome in acute ischemic stroke (AIS) patients with reperfusion therapy. We consecutively enrolled AIS patients with reperfusion therapy. UA was measured upon admission and during hospitalization. The change in UA levels (ΔUA) was determined by calculating the difference between admission UA and the lowest UA among all follow-up measurements, with a positive ΔUA suggesting a decrease in UA levels. Functional outcome was assessed by modified Rankin Scale (mRS) at 3months. Poor outcome was defined as mRS >2. A total of 361 patients were included (mean age 68.7±13.9years, 54.3% males). The mean UA on admission was 355±96.1μmol/L. The median ΔUA was 121μmol/L (IQR 50-192μmol/L) and 18 (5%) patients had increased UA levels. UA on admission was positively associated with good outcome (p for trend=0.017). When patients were classified into quartiles by ΔUA, patients with the largest decrease in UA (Q4: 199-434μmol/L) had a higher risk of poor outcome at 3months compared to patients with the least decrease in UA (Q1: 0-57μmol/L) (OR 2.55, 95% CI 1.09-5.98, p=0.031). The risk of poor outcome increased with ΔUA (p for trend=0.048). In patients with reperfusion therapy, high UA on admission was associated with a good 3-month outcome, while a greater decrease in UA was associated with poor outcome.