Title:U-Shaped Association Between Serum Uric Acid and Hemorrhagic Transformation
After Intravenous Thrombolysis
Volume: 19
Issue: 2
Author(s): Zicheng Cheng, Zhenxiang Zhan, Yaming Fu, Wen Yuan Zhang, Lingfan Xia, Tong Xu, Hongfang Chen*Zhao Han*
Affiliation:
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University,
Wenzhou, China
Keywords:
Uric acid, hemorrhagic transformation, acute ischemic stroke, intravenous thrombolysis, alteplase, hemorrhage.
Abstract:
Background: Uric acid (UA) has both antioxidative and pro-oxidative properties. The
study aimed to investigate the relationship between serum UA and hemorrhagic transformation (HT)
after intravenous thrombolysis in patients with acute ischemic stroke.
Methods: The patients undergoing intravenous thrombolysis from two hospitals in China were retrospectively
analyzed. HT was evaluated using computed tomography images reviewed within 24-
36h after thrombolysis. Symptomatic intracranial hemorrhage (sICH) was defined as HT accompanied
by worsening neurological function. Multivariate logistic regression and spline regression
models were performed to explore the relationship between serum UA levels and the risk of HT and
sICH.
Results: Among 503 included patients, 60 (11.9%) were diagnosed with HT and 22 (4.4%) developed
sICH. Patients with HT had significant lower serum UA levels than those without HT (245
[214-325 vs. 312 [256-370] μmol/L, p < 0.001). Multivariable logistic regression analysis indicated
that patients with higher serum UA levels had a lower risk of HT (OR per 10-μmol/L increase 0.96,
95%CI 0.92–0.99, p = 0.015). Furthermore, multiple-adjusted spline regression models showed a Ushaped
association between serum UA levels and HT (p < 0.001 for non-linearity). Similar results
were present between serum UA and sICH. Restricted cubic spline models predicted the lowest risk
of HT and sICH when the serum UA levels were 386μmol/L.
Conclusion: The data show the U-shaped relationship between serum UA levels and the risk of HT
and sICH after intravenous thrombolysis.
