Falsetti Lorenzo, Capeci William, Tarquinio Nicola, Viticchi Giovanna, Silvestrini Mauro, Catozzo Vania, Fioranelli Agnese, Buratti Laura, Pellegrini Francesco
Internal and Sub-intensive Medicine Department, Ospedali Riuniti Hospital, Ancona.
Department of Internal Medicine, Santa Casa Hospital, Loreto (AN).
Neurol Int. 2017 Mar 27;9(1):6920. doi: 10.4081/ni.2017.6920. eCollection 2017 Feb 20.
Chronic kidney disease and hyperuricemia have been associated to an increased risk and a worse prognosis in acute ischemic stroke. Several mechanisms, including platelet dysfunction, coagulation disorders, endothelial dysfunction, inflammation, and an increased risk of atrial fibrillation could be implicated. The role of serum uric acid in this setting is still object of debate. We enrolled all the consecutive patients admitted to our department for acute ischemic stroke. Cox regression analysis was used to evaluate the risk of in-hospital death considering serum uric acid levels and all the comorbidities. In the overall sample, hyperuricemia was independently associated to an increased risk of in-hospital mortality. This effect was stronger in patients with chronic kidney disease while, in the group of patients with normal renal function, the relationship between hyperuricemia and increased stroke mortality was not confirmed. Hyperuricemia could be associated to higher in-hospital mortality for ischemic stroke among elderly patients when affected by kidney disease. Survival does not seem to be affected by hyperuricemia in patients with normal kidney function.
慢性肾脏病和高尿酸血症与急性缺血性卒中风险增加及预后较差相关。可能涉及多种机制，包括血小板功能障碍、凝血紊乱、内皮功能障碍、炎症以及心房颤动风险增加。血清尿酸在这种情况下的作用仍存在争议。我们纳入了所有连续入住我科的急性缺血性卒中患者。采用Cox回归分析，考虑血清尿酸水平和所有合并症来评估院内死亡风险。在总体样本中，高尿酸血症与院内死亡风险增加独立相关。这种效应在慢性肾脏病患者中更强，而在肾功能正常的患者组中，高尿酸血症与卒中死亡率增加之间的关系未得到证实。老年肾病患者发生缺血性卒中时，高尿酸血症可能与更高的院内死亡率相关。肾功能正常的患者，高尿酸血症似乎不影响生存。
