Zhang Wenyuan, Cheng Zicheng, Fu Fangwang, Zhan Zhenxiang
Department of Neurology, Affiliated Yueqing Hospital of Wenzhou Medical University, Yueqing, China.
Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
Front Aging Neurosci. 2023 Sep 1;15:1223015. doi: 10.3389/fnagi.2023.1223015. eCollection 2023.
There have been contradictory findings regarding the relationship between serum uric acid levels and prognosis in acute ischemic stroke. Whether this association is nonlinear due to uric acid's paradoxical properties (antioxidant and prooxidant) is unclear.
We searched PubMed, Web of Science, and Embase databases until December 2022. Cohort studies reporting serum uric acid levels and functional outcome, mortality, or neurological complications in patients with acute ischemic stroke were included. Summary effect estimates were calculated using a random-effect model. Moreover, dose-response relationships were assessed by the generalized least squares trend estimation.
Altogether, 13 cohort studies were identified in this study. Compared to the lowest baseline serum uric acid levels, the highest levels were associated with decreased risk of poor functional outcome (OR = 0.70, 95% CI 0.54-0.91, = 29%), hemorrhagic transformation (OR = 0.15, 95% CI 0.05-0.42, = 79%), and post-stroke depression (OR = 0.04, 95% CI 0.00-0.95, = 89%), but not associated with mortality and symptomatic intracerebral hemorrhage. A nonlinear relationship was observed in poor functional outcome (U-shaped, for nonlinearity = 0.042), hemorrhagic transformation (inverse, for nonlinearity = 0.001), and post-stroke depression (inverse, for nonlinearity = 0.002). In addition, there was a single study reporting a U-shaped association in post-stroke epilepsy ( for nonlinearity <0.001). Furthermore, another study reported a positive curvilinear association in stroke recurrence ( for nonlinearity <0.05). The insufficient number of original articles for some prognostic indicators should be considered when interpreting the results of this meta-analysis.
In patients with acute ischemic stroke, serum uric acid levels are nonlinearly associated with the risk of poor functional outcome (U-shaped). More evidence is needed to confirm the association between serum uric acid levels and neurological complications following acute ischemic stroke.
关于急性缺血性卒中患者血清尿酸水平与预后之间的关系，已有相互矛盾的研究结果。由于尿酸具有矛盾的特性（抗氧化和促氧化），这种关联是否呈非线性尚不清楚。
我们检索了截至2022年12月的PubMed、Web of Science和Embase数据库。纳入报告急性缺血性卒中患者血清尿酸水平及功能结局、死亡率或神经并发症的队列研究。采用随机效应模型计算汇总效应估计值。此外，通过广义最小二乘趋势估计评估剂量反应关系。
本研究共纳入13项队列研究。与最低基线血清尿酸水平相比，最高水平与功能结局不良风险降低（比值比[OR]=0.70，95%置信区间[CI]0.54 - 0.91，异质性检验I²=29%）、出血性转化（OR=0.15，95%CI 0.05 - 0.42，I²=79%）和卒中后抑郁（OR=0.04，95%CI 0.00 - 0.95，I²=89%）相关，但与死亡率和症状性脑出血无关。在功能结局不良（U形，非线性检验P=0.042）、出血性转化（倒U形，非线性检验P=0.001）和卒中后抑郁（倒U形，非线性检验P=0.002）方面观察到非线性关系。此外，有一项研究报告卒中后癫痫呈U形关联（非线性检验P<0.001）。另外，另一项研究报告卒中复发呈正曲线关联（非线性检验P<0.05）。在解释本荟萃分析结果时，应考虑某些预后指标的原始文章数量不足的情况。
在急性缺血性卒中患者中，血清尿酸水平与功能结局不良风险呈非线性关联（U形）。需要更多证据来证实急性缺血性卒中后血清尿酸水平与神经并发症之间的关联。
