scholarly journals High serum uric acid levels are a protective factor against unfavourable neurological functional outcome in patients with ischaemic stroke

2018 ◽  
Vol 46 (5) ◽  
pp. 1826-1838 ◽  
Author(s):  
Yu-Fang Wang ◽  
Jiao-Xing Li ◽  
Xun-Sha Sun ◽  
Rong Lai ◽  
Wen-Li Sheng
Keyword(s):  
Uric Acid ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Serum Uric Acid ◽  
Acute Ischaemic Stroke ◽  
Neurological Outcome ◽  
Functional Outcomes ◽  
Protective Factor ◽  
High Serum ◽  
Large Artery

Objective We aimed to evaluate the association between serum uric acid levels at the onset and prognostic outcome in patients with acute ischaemic stroke. Methods We retrospectively analysed the outcomes of 1166 patients with ischaemic stroke who were hospitalized in our centre during August 2008 to November 2012. Correlations of serum uric acid levels and prognostic outcomes were analysed. Results Men had higher serum uric acid levels and better neurological functional outcomes compared with women. There was a strong negative correlation between serum uric acid levels and unfavourable neurological functional outcomes. Generalized estimated equation analysis showed that a higher serum uric acid level (>237 µmol/L) was a protective factor for neurological functional outcome in male, but not female, patients. Among five trial of ORG 10172 in acute stroke treatment classification subtypes, only patients with the large-artery atherosclerosis subtype had a significant protective effect of serum uric acid levels on neurological outcome. Conclusions Our study shows that high serum uric acid levels are a significant protective factor in men and in the large-artery atherosclerosis subtype in patients with ischaemic stroke. This is helpful for determining the prognostic value of serum uric acid levels for neurological outcome of acute ischaemic stroke.

Serum uric acid levels and outcome during admission in acute ischaemic stroke, depending on renal function

2018 ◽  
Vol 128 (10) ◽  
pp. 906-912 ◽  
Author(s):  
José Carlos Arévalo-Lorido ◽  
Juana Carretero-Gómez ◽  
Nicolás Roberto Robles
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Ischaemic Stroke ◽  
Serum Uric Acid ◽  
Acute Ischaemic Stroke

The natural tissue plasminogen activator inhibitor neuroserpin and acute ischaemic stroke outcome

2011 ◽  
Vol 105 (03) ◽  
pp. 421-429 ◽  
Author(s):  
Tomás Sobrino ◽  
Elena Miranda ◽  
David Brea ◽  
Natalia Pérez de la Ossa ◽  
Miguel Blanco ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Acute Ischaemic Stroke ◽  
High Serum ◽  
Favourable Outcome ◽  
Neuroprotective Effects ◽  
Good Functional Outcome ◽  
Tissue Plasminogen

SummaryNeuroserpin is a brain-derived natural inhibitor of tissue plasminogen activator (tPA) that has shown neuroprotective effects in animal models of brain ischaemia. Our aim was to investigate the association of neuroserpin levels in blood with functional outcome in patients with acute ischaemic stroke. Due to the potential effect of tPA treatment interfering on neuroserpin levels, we studied two different cohorts: 129 patients not treated with tPA and 80 patients treated with intravenous tPA within 3 hours (h) from symptoms onset. Neuroserpin levels were measured by ELISA. Good functional outcome at three months was defined as Rankin scale score ≤2. In the two cohorts, serum neuroserpin levels on admission were significantly higher than at 24 h, 72 h and in healthy subjects. In non tPA-treated patients, neuroserpin levels decrease at 24 h, but not levels at baseline, were associated with good outcome (for each quartile decrease, adjusted odds ratio [OR] 15.0; 95% confidence interval [CI], 3.5 to 66). In the tPA-treated cohort, high neuroserpin levels before tPA bolus had the stronger effect on favourable outcome (for each quartile, OR 13.5; 95%CI, 3.9 to 47). Furthermore, for each quartile in neuroserpin levels before tPA bolus there was a 80% (95%CI, 48 to 92) reduction in the probability of subsequent parenchymal haematoma. In summary, high serum neuroserpin levels before intravenous tPA and neuroserpin levels decrease at 24 h after ischaemic stroke, independently of tPA treatment, are associated with good functional outcome. These findings support the concept that neuroserpin might play an important role during cerebral ischaemia.

scholarly journals Significant aortic stenosis associated with poorer functional outcomes in patients with acute ischaemic stroke undergoing endovascular therapy

2020 ◽  
Vol 26 (6) ◽  
pp. 793-799
Author(s):  
Nicholas JH Ngiam ◽  
Benjamin YQ Tan ◽  
Ching-Hui Sia ◽  
Bernard PL Chan ◽  
Gopinathan Anil ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Functional Outcomes ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Background and aim Bi-directional feedback mechanisms exist between the heart and brain, which have been implicated in heart failure. We postulate that aortic stenosis may alter cerebral haemodynamics and influence functional outcomes after endovascular thrombectomy for acute ischaemic stroke. We compared clinical characteristics, echocardiographic profile and outcomes in patients with or without aortic stenosis that underwent endovascular thrombectomy for large vessel occlusion acute ischaemic stroke. Methods Consecutive acute ischaemic stroke patients with anterior and posterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery and basilar artery) who underwent endovascular thrombectomy were studied. Patients were divided into those with significant aortic stenosis (aortic valve area <1.5 cm2) and without. Univariate and multivariate analyses were employed to compare and determine predictors of functional outcomes measured by modified Rankin scale at three months. Results We identified 26 (8.5%) patients with significant aortic stenosis. These patients were older (median age 76 (interquartile range 68–84) vs. 67 (interquartile range 56–75) years, p = 0.001), but similar in terms of medical comorbidities and echocardiographic profile. Rates of successful recanalisation (73.1% vs. 78.0%), symptomatic intracranial haemorrhage (7.7% and 7.9%) and mortality (11.5% vs. 12.6%) were similar. Significant aortic stenosis was independently associated with poorer functional outcome (modified Rankin scale >2) at three months (adjusted odds ratio 2.7, 95% confidence interval 1.1–7.5, p = 0.048), after adjusting for age, door-to-puncture times, stroke severity and rates of successful recanalisation. Conclusion In acute ischaemic stroke patients managed with endovascular thrombectomy, significant aortic stenosis is associated with poor functional outcome despite comparable recanalisation rates. Larger cohort studies are needed to explore this relationship further.

scholarly journals Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

2017 ◽  
Vol 7 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Chee-Keong Wee ◽  
William McAuliffe ◽  
Constantine C. Phatouros ◽  
Timothy J. Phillips ◽  
David Blacker ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Controlled Trial ◽  
Group Versus ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Neurological Improvement

Background and Purpose: Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks. We aimed to survey the proportion of patients suitable for EVT who are alteplase-ineligible and to compare the safety and effectiveness of standard care of acute large artery ischaemic stroke by EVT plus thrombolysis with that of EVT alone in a tertiary hospital clinical stroke service. Methods: We performed a retrospective analysis of acute ischaemic stroke patients treated with EVT at our centre between October 2013 and April 2016, based on a registry with prospective and consecutive patient collection. Individual patient records were retrieved for review. Significant early neurological improvement was defined as a NIHSS score of 0–1, or a decrease from baseline of ≤8, at 24 h after stroke onset. Results: Fifty patients with acute ischaemic stroke secondary to LVO in the anterior circulation received EVT in this period, of whom 21 (42%) received concurrent alteplase and 29 (58%) EVT alone. The 2 groups had similar baseline characteristics and similar outcomes. Significant neurological improvement at 24 h occurred in 47.6% of the patients with EVT and bridging alteplase and in 51.7% of the patients with EVT alone (p = 0.774). Mortality during acute hospitalization was 20% for the bridging alteplase group versus 7.1% for EVT alone (p = 0.184). Intracranial haemorrhage rates were 14.3% for bridging alteplase versus 20.7% for EVT alone (p = 0.716). Local complications, groin haematoma (23.8 vs. 10.3%) and groin pseudoaneurysms (4.8 vs. 0%) (p = 0.170), were not significantly different. Conclusion: Our study highlights the relatively large proportion of patients suitable for EVT who have a contraindication to alteplase and raises the hypothesis that adding alteplase to successful EVT may not be necessary to optimize functional outcome. The results are consistent with observational data from other endovascular centres and support a randomised controlled trial of EVT versus EVT with bridging alteplase.

scholarly journals SERUM URIC ACID LEVEL IN ACUTE ISCHAEMIC STROKE

2013 ◽  
Vol 2 (36) ◽  
pp. 6915-6926
Author(s):  
Arvind Charan Mangal ◽  
Rishi T Guria ◽  
Manish Kumar Singh
Keyword(s):  
Uric Acid ◽  
Ischaemic Stroke ◽  
Serum Uric Acid ◽  
Uric Acid Level ◽  
Acute Ischaemic Stroke ◽  
Acid Level ◽  
Serum Uric Acid Level

scholarly journals TO STUDY SERUM URIC ACID AS A RISK FACTOR IN ACUTE ISCHAEMIC STROKE

2017 ◽  
Vol 6 (08) ◽  
pp. 647-652
Author(s):  
Krishan Oberoi ◽  
Ashwani Kumar Sharma ◽  
Sushant Garg ◽  
Rajiv Sharma ◽  
Bhupinder Singh ◽  
...  
Keyword(s):  
Uric Acid ◽  
Risk Factor ◽  
Ischaemic Stroke ◽  
Serum Uric Acid ◽  
Acute Ischaemic Stroke

scholarly journals Effect of Serum Uric Acid Level on Acute Ischaemic Stroke Patients in South Indian Population: A Prospective Cohort Study

2021 ◽  
Author(s):  
Karri Vijaya Phani Vardhan Reddy ◽  
Subramaniam Murugesan ◽  
Thangavelu Arun Prakash ◽  
Balasubramani Soorya Narayanan
Keyword(s):  
Uric Acid ◽  
Cohort Study ◽  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Serum Uric Acid ◽  
Acute Ischaemic Stroke ◽  
Elevated Serum ◽  
Acid Group ◽  
Stroke Patients ◽  
Short Term

Introduction: Stroke is one of the most common causes of morbidity and mortality in the world. Various studies have shown the correlation between the uric acid levels and acute ischaemic stroke. There are several studies which project the cerebro-protective effect of uric acid in acute ischaemic stroke patients by its antioxidant effect. However, still it is a wide area of controversy. Aim: To assess the short term (14 days) clinical outcomes in acute ischaemic stroke patients with reference to their serum uric acid levels on day of admission day. Materials and Methods: This prospective cohort study, which included a total of 74 acute ischaemic stroke patients who presented to Emergency Department in a Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry (a tertiary care hospital in South India) within 48 hours from the month of April 2018 and June 2019. The severity of stroke was quantified in all patients using National Institute of Health Stroke Scale (NIHSS) during admission and serum uric acid levels and other routine investigations were measured in all cases. All patients were managed as per American Heart Association (AHA) guidelines and at the end of 14 days their outcome was reassessed by modified Rankin Scale (mRS). The correlation between severity of stroke and the clinical outcome on 14 days with reference to admission day serum uric acid was analysed. Results: A total of 74 patients were analysed, 51 were male and 23 were females and mean serum uric acid was 6.07±0.78 (mg/dL), and mean NIHSS score at admission was 18.32±3.8. Severity assessment by NIHSS scoring system showed majority percentage of population in elevated serum uric acid group were in moderate and severe categories (73.7%, 62.9%, respectively) in adjunct with normal uric acid group. Outcome assessment by mRS showed major percentage population in elevated uric acid group with score 2,3 (score 2-89.3%, score 3-80%) in relation to normal uric acid group. Conclusion: The present study supported the hypothesis that acute ischaemic stroke patients with elevated serum uric acid levels at the time of admission had reduced severity and favourable short term clinical outcome due to its neuroprotective effect secondary to antioxidant property.

scholarly journals Evaluation of serum uric acid in acute ischaemic stroke

2017 ◽  
Vol 4 (1) ◽  
pp. 60
Author(s):  
Inderjeet Kaur ◽  
Ashok Khurana ◽  
Jasmine Kaur Sachdev ◽  
Gurinder Mohan
Keyword(s):  
Uric Acid ◽  
Risk Factor ◽  
Ischaemic Stroke ◽  
Serum Uric Acid ◽  
Acute Ischaemic Stroke ◽  
Serum Uric Acid Level ◽  
Increased Risk ◽  
The Difference ◽  
Stroke Evolution ◽  
Gcs Score

Background: The role of serum uric acid as a risk factor for acute ischaemic stroke is controversial and there is little information about it. Present study was done to estimate serum uric acid levels in patients of acute ischaemic stroke and to assess its risk factor potential.Methods: It was a prospective case control study carried out in the department of Medicine at Sri Guru Ramdas Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India from January 2015 to July 2016. 50 cases of acute ischaemic stroke were enrolled and were compared with same number of age and sex matched healthy controls. Serum uric acid levels were measured in cases (within 24 hours of stroke evolution). Glasgow coma scale (GCS) score was calculated for cases at time of admission. The results were statistically analysed.Results: Mean serum uric acid level in cases was 6.15±1.91mg/dl whereas it was 5.1±1.4 mg/dl in controls. The difference of serum uric acid levels between cases and controls was statistically significant (p = 0.0054). Patients with poor GCS had higher mean serum uric acid levels as compared to patients with mild or moderate GCS score which was statistically significant(p = 0.0426).Conclusions: Serum uric acid can be used as a marker for increased risk of stroke. Furthermore, serum uric acid can also be used for risk stratification after stroke.

scholarly journals A study to find out relationship in between serum uric acid level and stroke

2017 ◽  
Vol 4 (5) ◽  
pp. 1255
Author(s):  
Vishwa Deepak Tripathi ◽  
Zakir Hussain
Keyword(s):  
Uric Acid ◽  
Ischaemic Stroke ◽  
Serum Uric Acid ◽  
Uric Acid Level ◽  
Acute Ischaemic Stroke ◽  
Acid Level ◽  
Significant Positive Correlation ◽  
Serum Uric Acid Level ◽  
Normal Serum ◽  
Stroke Patients

Background: The role of uric acid as a risk factor in cases of acute ischaemic stroke is controversial. The present study was conducted with the aim to study the clinical profile and the incidence of stroke in patients with normal and elevated uric acid and its correlation with other risk factors.Methods: This study was conducted in 100 patients with acute ischaemic stroke who were admitted in NSCB Hospital Jabalpur from August 2009 to July 2010.Clinical records of patients and their serum uric acid level was investigated. The severity of neurological deficit was recorded according to the scandinavian stroke scale (SSS). Patients were followed up during hospital stay and outcome was graded by using modified Rankin’s scale (mRS). Finally, collected data were analyzed using Chi square and student t test wherever appropriate. P value <0.05 was considered significant.Results: A total of 100 patients were included in the study. Majority of the patients (57%) were in the age group of 50 to 70 years. Males (54%) were more affected than females (46%). Out of 100, 71 had normal serum uric acid levels in which 35 (49%) patients were above 60 years of age. 29 of them had hyperuricemia in which 20 (69%) were above the age of 60 years. Of 54 males and 46 females hyperuricemia was observed in 16 (55%) and 13 (45%) patients respectively. A significant correlation was observed between hyperuricemia and hypertension (p<0.05). Non-significant correlation was seen between hyperuricemia, diabetes and hyperlipidemia (p>0.05). Significant, positive correlation p<0.05 was present amongst male alcoholics. Association of uric acid with smoking in acute ischaemic stroke patients was found to be statistically insignificant (p>0.05). Majority (83%) of patients were having infarct in MCA artery territory. Majority of patients 20 (69%) with elevated serum uric acid were having SSS score >30. Statistically insignificant (p>0.05) association was observed between mean mRS score in patients with normal serum uric acid Vs patients with hyperuricemia.Conclusions: The prevalence of hyperuricemia in acute ischaemic stroke patients was lower than in normal population. Age, hypertension and alcoholism amongst males showed statistically significant positive correlation with hyperuricemia in patient with acute ischaemic stroke and hence they are considered to be the significant risk factors.

Management of Gouty Arthritis with special reference to Vatarakta - A Case Report

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
V. Balendu Krishnan ◽  
Prashanth A. S.
Keyword(s):  
Uric Acid ◽  
Case Report ◽  
Serum Uric Acid ◽  
Serum Uric Acid Level ◽  
Gouty Arthritis ◽  
Treatment Protocol ◽  
Joint Inflammation ◽  
High Serum ◽  
Common Disease ◽  
Disease Condition

Gouty Arthritis has now become a common disease condition which we deal in Ayurveda, but a proper treatment protocol is not followed in many cases. The case reported here was as a result of improper diet and lack of exercise which resulted in an increase serum uric acid level and joint inflammation. The treatment was given at IPD level diagnosing it as Gambhira Vatarakta with valid Chikitsa Siddhanta. This case report provides us a guidelines that even a chronic gouty arthritis with a very high serum uric acid can be treated as per Vataraktha Chikitsa Siddhanta in Ayurveda.

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