Low Serum Uric Acid may Help Predict Recurrence among acute ischemic stroke patients : Study

A recent study highlighted the potential significance of renal function-normalized serum uric acid (SUA) levels in predicting stroke outcomes, particularly in patients with acute ischemic stroke (AIS). While the relationship between serum uric acid and stroke outcomes has been debated due to its dependence on renal clearance, this research introduces the ratio of SUA to serum creatinine (SUA/SCr) as a promising predictor of stroke recurrence over a one-year period.

This prospective, multicenter observational study explored the association between SUA/SCr levels and the outcomes of stroke patients over one year. This research followed 2,294 patients with AIS and monitored them for stroke recurrence, all-cause mortality and overall prognosis. The study assessed how SUA/SCr levels correlated with these critical outcomes by using multivariable Cox regression analyses and restriction cubic splines.

The findings were particularly compelling in regard to stroke recurrence. The study revealed that for every one-unit increase in SUA/SCr, there was a corresponding 19% decrease in the risk of stroke recurrence within one year. This suggests that higher SUA/SCr levels could serve as a protective factor against future strokes in patients with AIS.

To better understand the impact of SUA/SCr levels, the study divided the patients into 4 quartiles (Q1-Q4) based on their SUA/SCr ratios. The results showed that patients in the higher quartiles (Q2, Q3, and Q4) had significantly lower risks of stroke recurrence when compared to the individuals in the lowest quartile (Q1). The trend test further confirmed a significant decrease in stroke recurrence from the lowest to the highest quartiles, highlighting the importance of maintaining a higher SUA/SCr ratio.

The study found no significant association between SUA/SCr levels and other outcomes, such as poor prognosis or all-cause mortality. This suggests that while SUA/SCr may play a critical role in reducing stroke recurrence, it does not necessarily impact the overall survival or recovery in the long term. The findings of this study suggest that low SUA/SCr could be an independent risk factor for stroke recurrence within a year following an initial AIS event. The negative but nonlinear association between SUA/SCr and stroke recurrence highlights the complexity of this relationship. While more research would be required to fully understand the underlying mechanisms, these results offer a new perspective on managing stroke patients and potentially preventing future strokes.

Reference:

Zhang, D., Liu, Z., Guo, W., Lu, Q., Lei, Z., Liu, P., Liu, T., Peng, L., Chang, Q., Zhang, M., Lin, X., Wang, F., & Wu, S. (2024). Association of serum uric acid to serum creatinine ratio with 1‐year stroke outcomes in patients with acute ischemic stroke: A multicenter observational cohort study. In European Journal of Neurology. Wiley. https://doi.org/10.1111/ene.16431