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Lower uric acid level may be associated with hemorrhagic transformation but not functional outcomes in patients with anterior circulation acute ischemic stroke undergoing endovascular thrombectomy


To determine the correlation of uric acid (UA) with hemorrhagic transformation (HT) and poor short-term functional outcomes in anterior circulation acute ischemic stroke (AIS) patients after endovascular thrombectomy (EVT). A retrospective analysis was conducted for anterior circulation AIS patients who underwent EVT at our hospital from 2015 to 2019. HT within 72 h was documented according to the European Cooperative Acute Stroke Study II Classification. Baseline demographic, clinical and laboratory data were compared between the HT and non-HT groups, and between patients with favorable and unfavorable outcomes on 90-day. A total of 247 AIS patients were enrolled, of which 92 (37.2%) and 85 (34.4%) experienced HT and had favorable functional outcomes at 3 months respectively. Patients with HT had significantly lower UA levels compared to those without HT (322.60 ± 94.49 vs. 350.25 ± 99.28 μmol /L, P = 0.032). In contrast, UA levels were similar in patients with good or poor outcomes (345.67 ± 103.55 vs. 336.95 ± 95.5 μmol /L, P = 0.509). Compared to the patients with UA levels in the first quartile, those in the fourth quartile were at a higher risk of HT in univariate logistic regression analysis (OR = 0.383, 95% CI = 0.173–0.848, P = 0.018). The association remained significant after multivariable adjustment for potential confounders. A lower UA level is an independent risk factor of HT post-EVT in anterior circulation AIS patients, but is not associated with the short-term functional outcomes.

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anterior cerebral artery


alberta stroke program early CT score


body mass index


diastolic blood pressure


estimated glomerular filtration rate


high density liptein cholesterol


hemorrhagic transformation


internal carotid artery


Large-Artery Atherosclerosis


low density liptein cholesterol


middle cerebral artery


modified thrombolysis in cerebral infarction


National Institute of Health stroke scale; OTP, onset-to-puncture


systolic blood pressure


uric acid


white blood cell


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Authors and Affiliations



All authors contributed signifcantly to this work. Z.Y.C. and Y.Y.S. designed the research study. Z.Y.C., H.B.C, Y.B.H., and Y.B.Z. performed the research study and collected the data; Z.Y.C. and H.B.C analyzed the data; Z.Y.C. wrote the frst draft of the manuscript; and Y.Y.S. revised the manuscript. All authors reviewed and approved the manuscript.

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Correspondence to Yingying Su.

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The authors declare that they have no conflict of interest.

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Our study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Xuan Wu Hospital.

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The informed consent requirement was waived due to the retrospective study design.

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Chen, Z., Chen, H., Zhang, Y. et al. Lower uric acid level may be associated with hemorrhagic transformation but not functional outcomes in patients with anterior circulation acute ischemic stroke undergoing endovascular thrombectomy. Metab Brain Dis 35, 1157–1164 (2020).

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  • Uric acid
  • Hemorrhagic transformation
  • Prognosis
  • Ischemic stroke
  • Endovascular thrombectomy