Serum uric acid predicts outcomes after intravenous thrombolysis in patients with acute ischemic stroke / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the correlation and predictive value of serum uric acid (SUA) and short-term clinical outcomes after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis in the First Affiliated Hospital of Kangda College of Nanjing Medical University from July 1, 2018 to March 31, 2022 were retrospectively enrolled. Fasting SUA, blood glucose and blood lipids were measured the next morning after admission. The modified Rankin Scale was used to evaluate the functional outcome at discharge. 0-2 points were defined as good outcome, and 3-6 points were defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent risk factors for poor short-term outcome in patients with AIS after intravenous thrombolysis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SUA for poor short-term outcome after intravenous thrombolysis. Results:A total of 291 patients were enrolled during the study. Among them, 197 (67.70%) were male, aged 65.02±11.56 years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 5 (interquartile range 3-11), and the SUA was 322.06±90.54 μmol/L. Univariate analysis showed that the age, proportions of patients with atrial fibrillation and cardiogenic embolism, baseline fasting blood glucose and NIHSS scores in the poor outcome group were significantly higher than those in the good outcome group, while the SUA after intravenous thrombolysis was significantly lower than that in the good outcome group (all P<0.05). Multivariable logistic regression analysis showed that higher SUA was independently associated with the good outcomes (odds ratio [ OR] 0.986, 95% confidence interval [ CI] 0.985-0.991; P<0.01), while older age ( OR 1.047, 95% CI 1.021-1.075; P<0.01) and baseline NIHSS score ( OR 1.155, 95% CI 1.063-1.254; P<0.01) were independently associated with the poor outcomes. ROC curve analysis showed that the area under the curve of poor outcome predicted by SUA was 0.642 (95% CI 0.552-0.732; P=0.002), the best cutoff value was 307.45 μmol/L, and the sensitivity and specificity of prediction were 57.7% and 68.0% respectively. Conclusion:Higher SUA is associated with the short-term outcome of patients with AIS after intravenous thrombolytic therapy, but its predictive value of the outcomes is limited.