Uric Acid and Cognitive Impairment in Patients with Acute Ischemic Stroke: A Meta-Analysis.

Serum uric acid (UA) has been suggested to be correlated with outcomes after stroke. We performed a meta-analysis to evaluate the association between serum UA and post-stroke cognitive impairment (PSCI) in patients with acute ischemic stroke (AIS). Relevant observational studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. Overall, eleven studies with 4246 patients of AIS were included, 2073 (48.8%) of them had PSCI. Pooled results showed that patients with PSCI had significantly higher level of serum UA as compared to those without PSCI (mean difference: 35.70 μmol/l, 95% confidence interval (CI): 8.36 to 63.01, p=0.01; I2=95%). Subgroup analysis showed significant higher level of serum UA in patients with PSCI evaluated during follow-up of 3 months to 3 years, but not for those evaluated during hospitalization (p for subgroup difference=0.01). In addition, results of meta-analysis also showed that compared to patients with lower serum UA, AIS patients with higher serum UA had increased risk of PSCI (odds ratio: 1.33, 95% CI: 1.02 to 1.73, p=0.04; I2=72%). Higher level of serum UA after disease onset may be a marker of increased risk of PSCI in patients with AIS. Although these findings need to be validated in large-scale prospective studies, the possible mechanisms underlying the association between UA and PSCI should be also investigated.

Yan X ，Ren Z ，Wen Q ，Jin X ，Wang Y ，Zhang W ... -  《-》

The association between serum uric acid level and the risk of cognitive impairment after ischemic stroke.

Post-stroke cognitive impairment (PSCI) is a severe complication of stroke. Predicting PSCI is difficult because some risk factors for stroke, such as blood glucose level and blood pressure, are affected by many other elements. Although recent studies have shown that high serum uric acid (UA) levels are associated with cognitive dysfunction and may be a risk factor for PSCI, its impact remains unclear. Accordingly, the present study aimed to explore the association between serum UA level and PSCI. In total, 274 patients who experienced acute cerebral infarction, confirmed between January 2016 and December 2018, were enrolled. Baseline data and biological indicators were recorded. According to the Montreal Cognitive Assessment (MoCA) scores, patients were divided into two groups: PSCI and non-PSCI. Logistic regression analysis was used to determine possible risk factors for PSCI. Results demonstrated that serum UA levels were significantly higher in the PSCI group than in the non-PSCI group. Multivariable logistic analysis revealed that age, years of education, and UA level were independent risk factors for PSCI. PSCI patients were subdivided according to serum UA level: high and low. Hypertension history and homocysteine (Hcy) levels differed significantly between the high and low UA level groups. Further analysis revealed that a history of hypertension and Hcy demonstrated a certain correlation (r = 0.163, 0.162; P < 0.05), suggesting that serum UA level was an independent risk factor for PSCI. These findings indicate that serum UA level was correlated with PSCI in post-stroke patients and is anticipated to be used in clinical practice to reduce the incidence of PSCI.

Sun J ，Lv X ，Gao X ，Chen Z ，Wei D ，Ling Y ，Zhang J ，Gu Q ，Liu J ，Chen W ，Liu S ... -  《-》

Elevated serum uric acid is associated with cognitive impairment in acute minor ischemic stroke patients.

Xu L ，Ouyang QR ，Xiong Q ，Huang LW ，Yu M ... -  《Heliyon》

Serum Uric Acid Levels and Outcome of Acute Ischemic Stroke: a Dose-Response Meta-analysis.

Previous meta-analyses have reported conflicting results regarding the relationship between baseline uric acid (UA) levels and acute ischemic stroke (AIS) outcomes. Therefore, we conducted a dose-response meta-analysis to elucidate the association's strength and shape. Studies on the association between baseline UA levels and AIS outcomes in the PubMed and EMBASE databases were searched from their inception to April 17, 2023. Two researchers independently reviewed the studies for inclusion. A total of 23 articles involving 15,733 patients with AIS were included. The analysis revealed a significant inverse correlation between UA levels and AIS outcomes. The linear trend estimation indicated that a 50-μmol/L increment in UA level was associated with a 21.7% lower risk of hemorrhagic transformation (odds ratio [OR]: 0.783; 95% confidence interval [CI]: 0.743, 0.826; I2 = 43.4%; n = 4), 7.0% lower risk of 90-day unfavorable outcome [modified Rankin scale score ≥ 2] (OR: 0.930; 95% CI: 0.875, 0.990; I2 = 0%; n = 3), and 7.5% lower risk of 90-day poor outcome [modified Rankin scale score ≥ 3] (OR: 0.925; 95% CI: 0.863, 0.990; I2 = 74.4%; n = 3) in patients with AIS after accounting for relevant covariates. A linear dose-response relationship exists between baseline UA levels and the outcome of patients with AIS within a certain range, with higher baseline UA levels associated with better outcomes after AIS. Further dose-response meta-analyses, including a larger number of original articles, are required to validate our findings.

Zhang P ，Wang R ，Qu Y ，Guo ZN ，Zhen Q ，Yang Y ... -  《-》

Serum TG/HDL-C level at the acute phase of ischemic stroke is associated with post-stroke cognitive impairment.

The ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) bears a relation with poor outcomes of acute ischemic stroke (AIS), but the impact of serum TG/HDL-C level on post-stroke cognitive impairment (PSCI) remains unknown. We conducted this prospective study to explore the association between TG/HDL-C and PSCI. Consecutive AIS patients from the Stroke Units of our hospital were prospectively enrolled between July 1, 2020, and June 30, 2021. Blood samples were collected within 24 h after admission. Cognition function was evaluated by the Montreal Cognitive Assessment (MoCA) at 3 months after stroke. We used logistic regression analyses to explore the relationship between TG/HDL-C and PSCI, and then used a receiver operating characteristic (ROC) analysis to assess the ability of acute TG/HDL-C for predicting PSCI. A total of 227 AIS patients were recruited. Compared with patients without PSCI, those with PSCI had a higher level of TG/HDL-C at admission (P < 0.01). The multivariate logistic regression analyses showed that TG/HDL-C level was independently associated with PSCI (P < 0.01). The area under the curve of the ROC for TG/HDL-C as predictor of PSCI was 0.701 (95%CI 0.635-0.768). The optimal cutoff value of TG/HDL-C to indicate PSCI was 1.564, which gave a sensitivity of 55.2% and specificity of 80.6%. Our study demonstrated that a higher level of TG/HDL-C at the acute phase of ischemic stroke predicted the presence of PSCI at 3 months after stroke.

Cheng Y ，Zhu H ，Chen J ，Li L ，Liu C ，Gao Y ，Sun D ... -  《-》