Study On The Correlation Between Serum Uric Acid Level And Hemorrhagic Transformation After Intravenous Thrombolysis In Patients With Acute Ischemic Stroke

Objective: Previous studies have shown that uric acid(UA)is a powerful water-soluble antioxidant and free radical scavenger.However,the relationship between serum uric acid(SUA)and hemorrhagic transformation(HT)is still controversial.This article aims to explore the relationship between SUA and HT after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods: A retrospective analysis of patients with anterior circulation AIS who received intravenous thrombolysis in our hospital from 2016 to 2021.HT was detected by brain CT within 7 days of admission.Use standardized forms to collect relevant demographic characteristics(age and gender),risk factors(hypertension,diabetes,atrial fibrillation,smoking and drinking history),baseline National Institutes of Health Stroke Scale(NIHSS)score,systolic blood pressure(SBP),diastolic blood pressure(DBP),time from onset to treatment,laboratory data(blood glucose,low-densitylipoprotein(LDL-C),adenosine deaminase,alkaline phosphatase,triglyceride,total serum Bilirubin,creatinine,urea nitrogen,homocysteine,D-dimer,fibrinogen,neutrophils,lymphocytes,hematocrit and platelet levels),the types of TOAST,and the types of HT.We divided HT into two categories according to ECASS III: Hemorrhagic infarction(HI)and Parenchymal hematoma(PH).The two are divided into two types,HI1 type: small spot hemorrhage at the infarct edge;HI2 type: fusion spots appear in the infarct area without mass effect;PH1 type: the hematoma area is less than30% of the infarct area,and the mass occupying effect is light;PH2 type: the hematoma area is greater than 30% of the infarct area,and the space-occupying effect is more obvious.All venous blood samples were collected within 48 hours after thrombolytic therapy.The collected data were checked again and analyzed using reasonable statistical methods.Variables were categorised using proportional tables and compared using chi-square or Fisher’s exact tests.Continuous variables were expressed as mean ± standard deviation or median and were compared using independent samples t-test or Mann-Whitney U test,one-way ANOVA or Kruskal-Wallis H test when necessary.Variables were selectively incorporated into logistic regression models to explore the relationship between serum SUA levels and HT.Results: A total of 727 AIS patients with an average age of 64 years were enrolled in this study.Males accounted for 70.00%.Among them,112 cases were HT,including 31 cases of HI1,32 cases of HI2,16 cases of PH1,and 13 cases of PH2.Compared with the non-HT group,patients with diabetes(P=0.013),atrial fibrillation(P<0.001),and cardioembolism(P<0.001)have a higher risk of HT,and small artery occlusion(SAO))Patients have a lower risk of HT(P<0.001);NIHSS score(P<0.001),SBP(P=0.001),DBP(P=0.006),blood glucose(P=0.006),and urea nitrogen(P=0.018)of patients in the HT group,D-dimer(P<0.001),fibrinogen(P<0.001),neutrophils(P<0.001)have higher levels,while the levels of SUA(P<0.001),lymphocytes(P=0.002),hematocrit(P=0.042)and platelets(PLT)(P=0.039)are lower.After converting UA into an ordinal variable,a multivariate logistic regression was performed.After adjusting for potential confounding factors,SUA and HT were negatively correlated.Compared with the first group of quartiles,the fourth group of patients had a significantly lower risk of HT(OR 0.266,95% CI 0.107-0.661,P=0.006).Patients with larger bleeding areas had higher levels of blood glucose(P=0.046),creatinine(P=0.028),D-dimer(P<0.001),and neutrophils(P=0.025).However,there was no significant difference in UA levels between the HT type groups(P = 0.907).The ROC curve below the diagonal line indicates that UA may be a protective factor for HT,with a cut-off value of 218.5 μmol/L,a sensitivity of 55.4%,and a specificity of 13.3%.In addition,in the correlation analysis,the level of SUA may be related to the NHISS score and some laboratory indicators such as creatinine,TT,and lymphocyte levels.Conclusions: These findings suggest that low levels of UA may be associated with HT after IVT.Although lower SUA levels may be associated with a higher risk of HT after IVT in AIS patients,however,SUA levels were not associated with the severity of HT.