Research Article: Association of uric acid levels with the risk of severe CED in LVO-AIS patients after mechanical thrombectomy
Abstract:
Cerebral edema (CED) significantly exacerbates mortality in patients with acute ischemic stroke (AIS) and can offset the benefits of endovascular therapy. Uric acid (UA) is recognized for its potential neuroprotective properties. This study aimed to investigate the association between serum UA levels and moderate-to-severe CED in large-vessel occlusion (LVO-AIS) patients following mechanical thrombectomy (MT).
We retrospectively analyzed 272 patients with anterior circulation LVO-AIS who achieved successful reperfusion (mTICI grade 2b-3) after MT. Patients were categorized into mild and moderate-to-severe CED groups, Multivariate logistic regression and interaction analyses were employed to determine the relationship between UA levels and the risk of moderate-to-severe CED.
Patients in the no-to-mild CED group exhibited significantly higher UA levels compared to the moderate-to-severe CED group (median 310.0 vs. 302.0??mol/L; p <?0.05). After adjusting for confounders (hypertension history, NIHSS, TICI, and ASPECT scores), higher UA levels were inversely correlated with moderate-to-severe CED risk (adjusted OR: 0.74; 95% CI: 0.56–0.99; p =?0.044). Interaction analysis revealed that this protective effect was more pronounced in patients with lower admission blood glucose (<7.5?mmol/L), higher mTICI grades (grade 3), and a history of hypertension (all P-interaction<0.06). Specifically, among patients with glucose<7.5?mmol/L, those with UA???360??mol/L had a 76% lower risk of moderate-to-severe CED (aOR: 0.24; 95% CI: 0.09–0.69; p =?0.033).
Higher serum UA levels may serve as a protective factor against moderate-to-severe CED following MT in LVO-AIS patients. This association is particularly significant in patients with lower glucose levels, optimal reperfusion (mTICI 3), and a history of hypertension.
Introduction:
Large vessel occlusion acute ischemic stroke (LVO-AIS) is associated with high mortality and disability rates, with the prognosis heavily reliant on timely and effective restoration of cerebral tissue perfusion. The efficacy of endovascular thrombectomy (EVT) for AIS has been established in randomized clinical trials (RCTs) ( 1 ). Despite its benefits in reducing mortality and improving functional outcomes, > 50% of patients still face a poor prognosis ( 2 ). Cerebral edema (CED) emerges as a significant…
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