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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

Abstract

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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Abbreviations

ACA:

anterior cerebral artery

ASPECTS:

alberta stroke program early CT score

BMI:

body mass index

DBP:

diastolic blood pressure

eGFR:

estimated glomerular filtration rate

HDL-C:

high density liptein cholesterol

HT:

hemorrhagic transformation

ICA:

internal carotid artery

LAA:

Large-Artery Atherosclerosis

LDL-C:

low density liptein cholesterol

MCA:

middle cerebral artery

mTICI:

modified thrombolysis in cerebral infarction

NIHSS:

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

SBP:

systolic blood pressure

UA:

uric acid

WBC:

white blood cell

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Contributions

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.

Corresponding author

Correspondence to Yingying Su.

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The authors declare that they have no conflict of interest.

Ethical approval

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). https://doi.org/10.1007/s11011-020-00601-7

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  • DOI: https://doi.org/10.1007/s11011-020-00601-7

Keywords

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