Liao Libin, Huang Weiquan, Ma Rongchao, Hu Wentong, Wu Hui, Su Moxi, Sha Dujuan
Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of General Practice, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Front Aging Neurosci. 2025 Jul 2;17:1580722. doi: 10.3389/fnagi.2025.1580722. eCollection 2025.
Cognitive impairment is the major complication of acute ischemic stroke, which is a significant health concern imposing a heavy economic burden on families and society. Studies have shown that the serum uric acid (SUA) level is correlated to clinical outcomes of stroke and neurogenerative diseases. The serum uric acid to serum creatinine ratio (SUA/SCr) is an independent risk factor for poor outcomes of acute ischemic stroke and can potentially become an effective diagnostic indicator for cognitive decline. In this study, we aimed to investigate the association between SUA/SCr and early-onset post-stroke cognitive impairment.
Consecutive acute ischemic stroke patients from our hospital were enrolled between June 2023 and September 2024. All blood samples were collected within 24 h after admission, and the cognitive function of patients was assessed within 2 weeks using the Chinese version of the Montreal Cognitive Assessment (MoCA). SUA/SCr was calculated by serum uric acid (umol/L)/serum creatinine (umol/L) and was split into three layers according to tertiles. The subjects were divided into a post-stroke cognitive impairment group and a non-post-stroke cognitive impairment group based on cognitive assessment. Binary logistic regression with different models, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curves were adopted to evaluate the predictive ability of SUA/SCr in early-onset post-stroke cognitive impairment.
The current study showed that the post-stroke cognitive impairment group had lower SUA/SCr ( = 0.005) and the lower tertile of SUA/SCr is associated with a higher prevalence of post-stroke cognitive impairment ( = 0.008). The multivariate logistic analysis indicated that SUA/SCr (OR = 0.560, 95% CI = 0.321-0.976, = 0.024) was independently associated with early-onset post-stroke cognitive impairment, and the lowest tertile was independently associated with a 5.903-fold increased risk of post-stroke cognitive impairment after adjusting for confounders. The optimal cutoff value of SUA/SCr to predict post-stroke cognitive impairment was 4.874, which gave a sensitivity of 72.22% and a specificity of 63.16%.
Our study revealed that SUA/SCr can be a potential indicator for post-stroke cognitive impairment in the early phase, a lower level of SUA/SCr upon admission was independently correlated to cognitive dysfunction after stroke.
认知障碍是急性缺血性卒中的主要并发症，这是一个重大的健康问题，给家庭和社会带来沉重的经济负担。研究表明，血清尿酸（SUA）水平与卒中和神经退行性疾病的临床结局相关。血清尿酸与血清肌酐比值（SUA/SCr）是急性缺血性卒中不良结局的独立危险因素，有可能成为认知功能下降的有效诊断指标。在本研究中，我们旨在探讨SUA/SCr与卒中后早期认知障碍之间的关联。
选取2023年6月至2024年9月我院连续收治的急性缺血性卒中患者。所有血样均在入院后24小时内采集，患者的认知功能在2周内使用中文版蒙特利尔认知评估量表（MoCA）进行评估。SUA/SCr通过血清尿酸（umol/L）/血清肌酐（umol/L）计算得出，并根据三分位数分为三层。根据认知评估将受试者分为卒中后认知障碍组和非卒中后认知障碍组。采用不同模型的二元逻辑回归、多因素逻辑回归分析和受试者工作特征（ROC）曲线来评估SUA/SCr对卒中后早期认知障碍的预测能力。
本研究表明，卒中后认知障碍组的SUA/SCr较低（=0.005），SUA/SCr的较低三分位数与卒中后认知障碍的较高患病率相关（=0.008）。多因素逻辑分析表明，SUA/SCr（OR=0.560，95%CI=0.321-0.976，=0.024）与卒中后早期认知障碍独立相关，在调整混杂因素后，最低三分位数与卒中后认知障碍风险增加5.903倍独立相关。预测卒中后认知障碍的SUA/SCr最佳截断值为4.874，其敏感性为72.22%，特异性为63.16%。
我们的研究表明，SUA/SCr可能是卒中后早期认知障碍的潜在指标，入院时较低的SUA/SCr水平与卒中后认知功能障碍独立相关。
