Correlation between serum uric acid with TOAST classification and prognosis in patients with first-onset acute ischemic stroke

doi:10.3969/j.issn.1004-583X.2024.03.003

Abstract

Abstract:

Objective To explore the correlation between serum uric acid (SUA) levels with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and long-term prognosis in patients with first-onset acute ischemic stroke (AIS). Methods A total of 199 patients with first-onset AIS who were hospitalized at Zhuhai People's Hospital from October 2020 to October 2021 were enrolled. They were divided into 4 groups based on SUA levels, which consisted of ≤280 μmol/L group (n=50), 280.1-331 μmol/L group (n=50), 331.1-398 μmol/L group (n=50) and >398 μmol/L group (n=49), and the correlation between SUA levels and TOAST classification was analyzed. The modified Rankin scale was used to evaluate the prognosis of patients after 3 months of onset, and the patients were assigned into good prognosis group (modified Rankin scale: 0-2 points, n=157) and poor prognosis group (modified Rankin scale: 3-6 points, n=42). The correlation between SUA levels and the prognosis of the two groups was compared. Results There was no statistically significant difference in TOAST classification among different SUA groups (P>0.05), but there were overall statistically significant differences in gender, proportion of dyslipidemia, and blood homocysteine levels (P<0.05). The ordinal multinomial logistic regression analysis indicated both male (OR=2.984, 95%CI: 1.603-5.553, P=0.001) and dyslipidemia (OR=2.600, 95%CI: 1.442-4.686, P=0.001) were associated with high SUA levels. There was no statistically significant difference in SUA levels between good prognosis group and poor prognosis group (P>0.05), but there was a statistically significant difference in baseline scores of National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI)(P<0.01). Binary logistic regression analysis showed a lower baseline score of BI was a risk factor for poor prognosis in the patients (OR=0.905, 95%CI: 0.867-0.944, P=0.000). Conclusion There was no correlation between SUA levels with TOAST classification and prognosis in patients with first-onset AIS, but both male and dyslipidemia were associated with high SUA levels, and a lower baseline score of BI indicated poor prognosis.

Key words: ischemic stroke, serum uric acid, TOAST classification, prognosis

CLC Number:

R743.3

Song Mengjiao, Wang Ruiqi, Cao Can, Cheng Guangsen, Liu Yu, Li Zhongliang, Yang Jianhao. Correlation between serum uric acid with TOAST classification and prognosis in patients with first-onset acute ischemic stroke[J]. Clinical Focus, 2024, 39(3): 216-221.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.03.003

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I3/216

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References 29

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项目	SUA(μmol/L)				H/χ²值	P值
项目	≤280(n=50)	280.1~331(n=50)	331.1~398(n=50)	>398(n=49)	H/χ²值	P值
年龄(岁)	61.00(54.50, 66.25)	60.00(52.00, 70.00)	61.00(52.75, 66.00)	57.00(49.00, 65.50)	1.754	0.625
性别[例(%)]
男女	32.00(64.00)^* 18.00(36.00)^*	32.00(64.00)^* 18.00(36.00)^*	41.00(82.00) 9.00(18.00)	46.00(93.88) 3.00(6.12)	17.406	0.001^a
吸烟[例(%)]	17.00(34.00)	21.00(42.00)	24.00(48.00)	25.00(51.02)	3.414	0.332^a
饮酒[例(%)]	12.00(24.00)	17.00(34.00)	20.00(40.00)	19.00(38.78)	3.517	0.319^a
高血压[例(%)]	35.00(70.00)	36.00(72.00)	30.00(60.00)	39.00(79.59)	4.643	0.200^a
糖尿病[例(%)]	15.00(30.00)	15.00(30.00)	13.00(26.00)	11.00(22.45)	0.992	0.803^a
血脂异常[例(%)]	30.00(60.00)^*	35.00(70.00)	39.00(78.00)	43.00(87.76)	10.707	0.013^a
血同型半胱氨酸(μmol/L)	12.03(10.50, 15.11)^*	13.85(11.70, 16.73)	15.95(13.63, 18.01)^#	15.90(13.71, 18.28)	25.110	0.000
基线NIHSS评分(分)	2.00(1.00, 5.00)	2.00(1.00, 3.00)	2.00(1.00, 3.00)	3.00(1.00, 4.00)	3.359	0.339
基线Barthel指数	85.00(60.00, 95.00)	90.00(78.75, 96.25)	87.50(70.00, 100.00)	80.00(65.00, 95.00)	4.615	0.202
TOAST分型[例(%)]
大动脉粥样硬化型	26.00(52.00)	31.00(62.00)	30.00(60.00)	25.00(51.02)
小动脉闭塞型	22.00(44.00)	16.00(32.00)	19.00(38.00)	21.00(42.86)
心源性栓塞型	1.00(2.00)	3.00(6.00)	0	1.00(2.04)	-	0.605^b
其他明确病因型	1.00(2.00)	0	1.00(2.00)	2.00(4.08)
不明原因型	0	0	0	0

项目	SUA(μmol/L)				H/χ²值	P值
项目	≤280(n=50)	280.1~331(n=50)	331.1~398(n=50)	>398(n=49)	H/χ²值	P值
年龄(岁)	61.00(54.50, 66.25)	60.00(52.00, 70.00)	61.00(52.75, 66.00)	57.00(49.00, 65.50)	1.754	0.625
性别[例(%)]
男女	32.00(64.00)^* 18.00(36.00)^*	32.00(64.00)^* 18.00(36.00)^*	41.00(82.00) 9.00(18.00)	46.00(93.88) 3.00(6.12)	17.406	0.001^a
吸烟[例(%)]	17.00(34.00)	21.00(42.00)	24.00(48.00)	25.00(51.02)	3.414	0.332^a
饮酒[例(%)]	12.00(24.00)	17.00(34.00)	20.00(40.00)	19.00(38.78)	3.517	0.319^a
高血压[例(%)]	35.00(70.00)	36.00(72.00)	30.00(60.00)	39.00(79.59)	4.643	0.200^a
糖尿病[例(%)]	15.00(30.00)	15.00(30.00)	13.00(26.00)	11.00(22.45)	0.992	0.803^a
血脂异常[例(%)]	30.00(60.00)^*	35.00(70.00)	39.00(78.00)	43.00(87.76)	10.707	0.013^a
血同型半胱氨酸(μmol/L)	12.03(10.50, 15.11)^*	13.85(11.70, 16.73)	15.95(13.63, 18.01)^#	15.90(13.71, 18.28)	25.110	0.000
基线NIHSS评分(分)	2.00(1.00, 5.00)	2.00(1.00, 3.00)	2.00(1.00, 3.00)	3.00(1.00, 4.00)	3.359	0.339
基线Barthel指数	85.00(60.00, 95.00)	90.00(78.75, 96.25)	87.50(70.00, 100.00)	80.00(65.00, 95.00)	4.615	0.202
TOAST分型[例(%)]
大动脉粥样硬化型	26.00(52.00)	31.00(62.00)	30.00(60.00)	25.00(51.02)
小动脉闭塞型	22.00(44.00)	16.00(32.00)	19.00(38.00)	21.00(42.86)
心源性栓塞型	1.00(2.00)	3.00(6.00)	0	1.00(2.04)	-	0.605^b
其他明确病因型	1.00(2.00)	0	1.00(2.00)	2.00(4.08)
不明原因型	0	0	0	0

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
性别(女性组为对照)	1.093	0.317	11.902	0.001	2.984	1.603	5.553
血脂异常(血脂正常组为对照)	0.955	0.301	10.103	0.001	2.600	1.442	4.686
血同型半胱氨酸	0.012	0.010	1.570	0.210	1.012	0.993	1.031

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
性别(女性组为对照)	1.093	0.317	11.902	0.001	2.984	1.603	5.553
血脂异常(血脂正常组为对照)	0.955	0.301	10.103	0.001	2.600	1.442	4.686
血同型半胱氨酸	0.012	0.010	1.570	0.210	1.012	0.993	1.031

项目	预后良好组(n=157)	预后不良组(n=42)	Z/χ²值	P值
年龄(岁)	60.00(52.00, 66.00)	60.00(51.75, 69.25)	0.587	0.557
性别[例(%)]
男女	120.00(76.43) 37.00(23.57)	31.00(73.81) 11.00(26.19)	0.125	0.724^a
吸烟[例(%)]	69.00(43.95)	18.00(42.86)	0.016	0.899^a
饮酒[例(%)]	53.00(33.76)	15.00(35.71)	0.056	0.812^a
高血压[例(%)]	112.00(71.34)	28.00(66.67)	0.347	0.556^a
糖尿病[例(%)]	41.00(26.11)	13.00(30.95)	0.392	0.531^a
血脂异常[例(%)]	116.00(73.89)	31.00(73.81)	0.000	0.992^a
血同型半胱氨酸(μmol/L)	14.41(12.00, 17.59)	14.81(11.78, 17.87)	0.321	0.748
基线NIHSS评分(分)	2.00(1.00, 3.00)	5.00(3.00, 8.00)	7.521	0.000
基线Barthel指数	90.00(80.00, 100.00)	60.00(45.00, 65.00)	-8.176	0.000
SUA( μmol/L)	324.00(278.50, 392.00)	351.50(289.50, 421.75)	1.071	0.284
SUA[例(%)]
≤280 μmol/L	41.00(26.11)	9.00(21.43)
280.1~331 μmol/L	42.00(26.75)	8.00(19.05)	2.190	0.534^a
331.1~398 μmol/L	38.00(24.20)	12.00(28.57)
>398 μmol/L	36.00(22.93)	13.00(30.95)
TOAST分型[例(%)]
大动脉粥样硬化型	86.00(54.78)	26.00(61.90)
小动脉闭塞型	64.00(40.76)	14.00(33.33)
心源性栓塞型	4.00(2.55)	1.00(2.38)	-	0.789^b
其他明确病因型	3.00(1.91)	1.00(2.38)
不明原因型	0	0
静脉溶栓[例(%)]	16.00(10.19)	8.00(19.05)	0.245	0.117^a
血管内介入治疗[例(%)]	20.00(12.74)	6.00(14.29)	0.070	0.792^a