Relationship Between Serum Uric Acid In Acute Phase And Short-term Outcomes Among Patients With Stroke

BackgroundThe association between serum uric acid and short-term clinical outcome of acutestroke is inconclusive, there were few related reports of large sample in China.PurposeTo explore the association between UA in the first24hours after admission andneurologic deficiency at discharge or death during hospitalization among patients withacute stroke, to provide scientific evidence for the effective treatment, rehabilitation andmanagement for the acute stroke patients.MethodsA total of3231acute stroke patients in four hospitals in Shandong province fromJanuary,2006to December,2008were included in the present study. Data ondemographic characteristics, life style risk factors, UA and other clinical laboratory testsin the first24hours after admission, medical history, neurological function evaluation(National Institutes of Health Stroke Scale，NIHSS) and death during hospitalizationwere obtained using a standard questionnaire administered by trained stuff from medicalrecords. Study outcomes (poor outcomes) was defined as NIHSS≥5at discharge ordeath during hospitalization. Statistic analysis was conducted using SPSS19.0software.Comparisons of the poor outcome distribution and baseline characteristics at admissionbetween the patients with poor outcome and without poor outcome were conducted, andodds ratios (ORs) and95%confidence interval (95%CI) of poor outcomes amongpatients with different UA in the first24hours after admission were calculated by usingmultiple logistic model, and linear tendency tests were conducted. Results1. Among3231acute stroke patients, the percentage of ischemic stroke (80.8%)was higher than that of hemorrhage stroke (9%). The rate of poor outcomes was higherin patients with hemorrhage stroke (69.1%) than that in those with ischemic stroke(42.3%), P<0.05.2. For patients with acute ischemic stroke, multivariate-adjusted ORs of pooroutcome for hyperglycemia, history of auricular fibrillation, history of rheumatic heartdisease, urea and erythrocyte sedimentation rate were2.145(1.733,2.665)，3.213(2.021,5.108)，4.864(2.132,11.097)，1.067(1.023，1.112) and1.015(1.004，1.026)，respectively, all P<0.05; For patients with acute hemorrhagic stroke,multivariate-adjusted ORs of poor outcome for age, hypertension and hyperglycemia atadmission were1.036(1.014,1.058),2.096(1.033,4.253) and1.976(1.158,3.370),respectively, all P<0.05.3. After adjustment for multivariate, ORs (95%CI) of poor outcome for everyincreased unit of UA was0.865(0.795,0.898) among patients with acute ischemicstroke. After adjustment for multivariate, ORs (95%CI) of poor outcome for everyincreased unit of UA was not significant among patients with acute hemorrhagic stroke.4. After adjustment for multivariate, ORs (95%CI) of poor outcome for acuteischemic stroke patients with UA of197-241μmol/L,242-285μmol/L,286-346μmol/Land≥347μmol/L were0.552(0.354,0.861),0.417(0.263,0.661),0.390(0.241,0.630)and0.352(0.213,0.581), respectively, compared to those with UA<197μmol/L, whichshowed a tendency that risk of poor outcome decreased with UA level. The ORs of pooroutcome for acute hemorrhagic stroke patients with UA of150-185μmol/L,186-230μmol/L,231-297μmol/L and≥298μmol/L were not significant, compared tothose with UA<150μmol/L.5. For male, after adjustment for multivariate, compared to those withUA<244μmol/L, ORs (95%CI) of poor outcome for acute ischemic stroke patients withUA of245-325μmol/L and≥326μmol/L were0.581(0.364,0.929) and0.378(0.223,0.641) respectively, but ORs of poor outcome were not significant for patientswith acute hemorrhagic stroke. For female, after adjustment for multivariate, comparedto those with UA<193μmol/L, ORs (95%CI) of poor outcome for acute ischemic strokepatients with UA of194-257μmol/L and≥258μmol/L were0.466(0.253,0.858) and 0.391(0.215,0.714), respectively, but ORs of poor outcome were not significant foracute hemorrhagic stroke patients.6. For acute ischemic stroke patients without hypertension, after adjustment formultivariate, compared to those with UA<227μmol/L, ORs (95%CI) of poor outcomefor UA of228-302μmol/L and≥303μmol/L were0.561(0.413,0.761) and0.541(0.392,0.745), respectively, but ORs of poor outcome were not significant foracute hemorrhagic stroke patients. For acute ischemic stroke patients with hypertension,after adjustment for multivariate, compared to those with UA<220μmol/L, ORs (95%CI) of poor outcome for UA of221-302μmol/L and≥303μmol/L were0.510(0.376,0.693) and0.498(0.359,0.691), respectively, but ORs of poor outcomewere not significant for acute hemorrhagic stroke patients.Conclusions1. Hyperglycemia, history of auricular fibrillation, history of rheumatic heartdisease, increased urea and increased erythrocyte sedimentation rate were risk factors ofpoor outcomes for ischemic stroke patients. Older age, hypertension at admission, andhyperglycemia were risk factors of poor outcomes for hemorrhagic stroke patients.2. Elevated UA is an independent predictor for short-term good clinical outcomeamong patients with acute ischemic stroke.3. Elected UA is not significantly associated with poor outcomes duringhospitalization among patients with acute hemorrhagic stroke.