Title: Pattern of change of serum uric acid level during acute ischemic stroke and their prognostic significance

Authors: Dr Sonika Pandey, Dr K K Kawre, Dr P. Dwivedi

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.171

Abstract

In Acute ischemic stroke (AIS) there is cascade of inflammatory reaction, and uric acid exert beneficial role in AIS due to its strong antioxidant property.

Aim: Aim was to study the pattern of change in serum uric acid (SUA) level and the association between SUA level at presentation and the clinical outcome in AIS patient.

Methodology: Single centre prospective cross sectional analytical hospital based time bound study. 100 consecutive patients admitted with AIS in medicine emergency were enrolled for study after considering the inclusion and exclusion criteria. Prognostic significance of SUA were analysed in term of NIHSS (national institute of health stroke scale) score (at admission, discharge, 90 days), hospital stay, and survival (at 90 days). Student t test and χ2 test was used to compare continuous and categorical variables respectively. Kaplain Meier survival plot was used for survival analysis.

Results: Mean SUA was (6.23mg/dl, SD±1.2) at admission, (5.64mg/dl, SD±0.98) discharge, (5.28mg/dl, SD±0.82) 90 days. Mean SUA shows significant inverse correlation with NIHSS score (p <0.0001, 0.001, 0.004 with r = -0.382,-0.403,-0.357) at admission, discharge and 90 days respectively. SUA shows significant negative correlation with hospital stay (p= 0.004, r= -0.342). The odds ratio of SUA at admission (cut off < 5.5 mg/dL) was 5.962 (2.08-17.09; CI 95%) showing more survival for SUA at admission > 5.5 mg/dL. The mortality rate, hospital stay, NIHSS score was found to be more in patient having diabetes or metabolic syndrome.

Conclusions: SUA is consumed during AIS. Higher SUA level is associated with low NIHSS score, reduced hospital stay, more survival and may act as good prognostic marker.

Keyword: AIS (acute ischemic stroke); SUA (serum uric acid); NIHSS (national institute of health stroke scale).

References

  1. Chamorro A, Obach V. Cervera A, Rvilla M, Dulofeu R, Aponte JH. Prognostic significance of uric acid serum concentration in patients with acute ischaemic stroke. Stroke 33(4), 1048-1052.
  2. Cherubini A, Polidori MC, Bregnocchi M, Pezzuto S, Cecchetti R, Ingegni T et al, Antioxidant Profile and Early Outcome in Stroke Patients. Stroke 2000;31; 2295- 2300
  3. Lehto S, Niskanen L, Ronnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non‐insulin dependent diabetes mellitus.Stroke 1998;29:635–9.
  4. Leinonen JS, Ahonen JP, Loernrot K et al. Plasma antioxidant capacity is associated with high lesion volume and neurological impairment in stroke. Stroke 31(9), 33-39 (2000).
  5. Love S. Oxidative stress in brain ischemia. Brain Pathol. 9(1), 119-131 (1999).
  6. inYu ZF, Bruce‐Keller AJ, Goodman Y, Mattson MP. Uric acid protects neurons against excitotoxic and metabolic insults in cell culture, and against focal ischemic brain injury in vivo.J Neurosci Res1998; 53:
  7. Polidori MC, Frei B, Cherubini A, Nelles G, Rordorf G, Keaney JFet al. Increased plasma levels of lipid hydroperoxides in patients with ischemic stroke. Free RadicBiol Med1998; 25:561–7.
  8. Tayag EC, Nair SN, Wahhab S, Katsetos CD, Lighthall JW, Lehmann JC. Cerebral uric acid increases following experimental traumatic brain injury in rat.Brain Res1996; 733:287–91.
  9. Brouns R, Wauters A, Van De Vijver G, et al. Decrease in uric acid in acute ischemic stroke correlates with stroke severity, evolution and outcome. Clin Chem Lab Med 2010; 48(3):383-90.
  10. Chen YC, Su CT, Wang ST, Lee HD, Lin SY. A preliminary investigation of the association between serum uric acid and impaired renal function. Chang Gung Med J 2009; 32(1):66-71.
  11. Chiquete E, Ruiz-Sandoval JL, Murillo-Bonilla LM et al serum uric acid and outcome after acute ischemic stroke: PREMIER study; Cerebrovasc Dis. 2013;35(2):168-74
  12. Wang Z, Lin Y, Liu Y. Serum uric acid levels and outcomes after acute ischemic stroke. Mol Neurobiol. 2016;53(3):1753-9.
  13. Abuja PM. Ascorbate prevents prooxidant effects of urate in oxidation of human low density lipoprotein. FEBS Lett. 1999;446:305-8.

Corresponding Author

Dr Sonika Pandey

Senior Resident, Dept of Medicine,

Gandhi medical college, Bhopal, Madhya Pradesh, India