New Study Reveals Uric Acid's Role in Stroke Recovery: Implications for Treatment

In a recent study published in the Journal of the American Heart Association, researchers shed light on the complex relationship between uric acid (UA) levels and recovery outcomes in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The study findings reveal that the uric acid levels and functional outcomes do not maintain a linear relationship but instead maintain an inverted u-shaped relation.

AIS is a notable global health issue due to increased incidence and mortality rates leading to profound disability and healthcare burden. Ultra‐early intravenous thrombolysis (IVT) has shown profound effectiveness in treating ischemic cerebrovascular disease. Uric acid levels have shown considerable correlation for post-stroke prognosis. Hence, researchers from Jilin University China conducted a study to investigate the relationship between uric acid (UA) levels and functional outcomes at 3 months in patients with acute ischemic stroke (AIS) who underwent intravenous thrombolysis (IVT).

The prospective cohort study enrolled 1001 consecutive AIS patients who underwent IVT and examined the correlation between UA levels and post‐IVT AIS outcomes. restricted cubic spline function was employed to assess the nonlinear relationship.

Findings:

• Contrary to previous assumptions, the researchers discovered a nonlinear association between UA levels and post-IVT AIS outcomes.
• Using a restricted cubic spline function, they found that the relationship was best described as an inverted U-shaped curve.
• At first glance, higher UA levels appeared to be associated with more favorable outcomes, as evidenced by lower modified Rankin Scale (mRS) scores (≤2) at the 3-month mark.
• However, further analysis revealed that the impact of UA levels on recovery varied depending on the presence of hyperuricemia.
• Among patients with hyperuricemia, higher UA levels were paradoxically linked to poorer outcomes. Specifically, for every 50 μmol/L increase in UA levels, the odds of achieving a favorable outcome decreased by 25%.
• Conversely, in patients without hyperuricemia, higher UA levels were associated with improved recovery outcomes.
• Here, a similar increase in UA levels corresponded to a 31% higher likelihood of achieving a favorable outcome.

The study concluded that Higher uric acid levels predict favorable outcomes (mRS ≤2) at 3 months in patients without hyperuricemia but unfavorable outcomes in those with hyperuricemia. The study findings have significant implications for stroke care. These help clinicians to tailor treatment strategies based on patients' UA status, ensuring personalized care that maximizes the chances of favorable outcomes. In conclusion, this groundbreaking study adds a new dimension to our understanding of stroke recovery. By unraveling the complex interplay between UA levels and treatment outcomes, researchers have paved the way for more targeted and effective approaches to stroke care.

Further reading: Baseline Uric Acid Levels and Intravenous Thrombolysis Outcomes in Patients With Acute Ischemic Stroke: A Prospective Cohort Study. Doi: https://doi.org/10.1161/JAHA.123.033407