Association Between Serum Uric Acid Levels and Cognitive Function in Patients with Ischemic Stroke and Transient Ischemic Attack (TIA): A 3-Month Follow-Up Study

Introduction: Leptomeningeal collaterals are native (pre-existing) anastomoses that cross-connect a small number of distal-most arterioles within the crowns of the cerebral artery trees. We seek to identify potentially modifiable determinants associated with variability in leptomeningeal collateral status in patients with acute ischemic stroke. Methods: Data is from the Keimyung Stroke Registry, a prospectively collected dataset of patients with acute ischemic stroke from Daegu, South Korea. Patients with M 1 segment middle cerebral artery (MCA) +/- intracranial internal carotid artery (ICA) occlusions on baseline CT-angio from May 2004 to July 2009 were included in the study.Baseline and follow-up imaging was analyzed at the imaging core lab of the Calgary Stroke Program. Two readers blinded to all clinical information assessed leptomeningeal collaterals on baseline CT-angio by consensus using the regional leptomeningeal score (rLMC). Results: Of 206 patients[mean age66.9±11.6 years, median baseline NIHSS 14 (IQR11-20), median stroke symptom onset to CT-angio time 166 minutes (IQR 96-262)], 133 patients (64.6%) had poor collateral status at baseline (rLMC score 11-20). On univariate analyses, patients with poor collateral status at baseline were older, hypertensive, had higher blood glucose values, higher white blood cell count at baseline, higher D-dimer and serum uric acid levels (measured next day morning) and were more likely to have metabolic syndrome as per ATP III criteria. Multivariable modeling identified metabolic syndrome (OR 3.22 95% CI 1.69-6.15, p<0.001), raised serum uric acid (per 1mg/dl OR 1.35 95% CI 1.12-1.62, p<0.01) and age (per year, OR 1.03 95% CI 1-1.05, p=0.03) as independent predictors of poor leptomeningeal collateral status at baseline. Conclusion: Metabolic syndrome and hyperuricemia are modifiable determinants associated with poor leptomeningeal collateral status in patients with acute ischemic stroke. This knowledge could potentially help in focusing research on appropriate therapeutic strategies for modulating function of leptomeningeal collaterals.

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One-year follow-up healthcare costs of patients hospitalized for transient ischemic attack or ischemic stroke and discharged with aspirin plus extended-release dipyridamole or clopidogrel

Journal of Medical Economics ◽

10.3111/13696998.2012.718020 ◽

2012 ◽

Vol 15 (6) ◽

pp. 1217-1225 ◽

Cited By ~ 3

Author(s):

Tanya M. Burton ◽

Michael Lacey ◽

Fang Liu ◽

Yanni Yu ◽

Maria Laura Monsalvo ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Healthcare Costs ◽

Extended Release ◽

One Year ◽

Ischemic Attack

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Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation

Cerebrovascular Diseases ◽

10.1159/000511393 ◽

2020 ◽

Vol 49 (6) ◽

pp. 619-624

Author(s):

Keisuke Tokunaga ◽

Masatoshi Koga ◽

Sohei Yoshimura ◽

Yasushi Okada ◽

Hiroshi Yamagami ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Left Atrial ◽

Nonvalvular Atrial Fibrillation ◽

Ischemic Event ◽

Increased Risk ◽

Ischemic Attack ◽

Ischemic Events

Background: The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF). Methods: Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism. Results: A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9–2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02–3.00). Conclusion: Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.

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AB0926 PERFORMANCE OF THE ACR-EULAR GOUT CLASSIFICATION CRITERIA FOR THE DIAGNOSIS GOUT IN CLINICAL PRACTICE: A ONE-YEAR FOLLOW-UP STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2457 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1763.1-1764

Author(s):

M. Gamala ◽

J. W. G. Jacobs ◽

S. Linn-Rasker ◽

M. Nix ◽

B. Heggelman ◽

...

Keyword(s):

Uric Acid ◽

Clinical Practice ◽

Serum Uric Acid ◽

Dual Energy ◽

Classification Criteria ◽

Dual Energy Ct ◽

Research Support ◽

Follow Up Study ◽

One Year

Background:Classification criteria are used for classifying groups of patients, especially for clinical trials, and diagnostic criteria for diagnosis in individual patients.Objectives:to establish the performance of the 2015 ACR/EULAR gout classification criteria for the diagnosis gout in patients with undifferentiated arthritis. Secondary, to explore the use and efficacy of uric acid lowering therapy (ULT) in daily clinical practice in new gout patients.Methods:1-year follow-up study was performed in subjects with unclassified arthritis, who had been classified as gout patients or not, according the gout classification criteria, including imaging with dual-energy CT, but without ultrasonography and joint X-rays.(1) The reference was the clinical diagnosis (gout yes/no) after 1-year follow-up.Results:71 patients were included; their demographic and clinical characteristics are summarized in Table 1. All 63/71 patients classified as having gout at baseline also had a clinical gout diagnosis after one year, and of the patients not classified, none had the clinical diagnosis of gout at one year.Table 1.Characteristics of the 71subjects included in analysesDiagnosis**gout (n=63)no gout (n=8)Age in years, mean (SD)62 (14)59 (14)Male gender, N (%)53 (84)5 (63)Symptom duration* at baseline in months, median (IQR)12 (1-48)8 (0.5-33)Joint involvement at baseline N patients (%):MTP,33 (52)1 (12)ankle/midfoot12 (19)1 (12)other joint18 (29)6 (76)SUA intercritical in umol/l, mean (SD)484 (63)337 (71)2015 ACR/EULAR criteria baseline score, mean (SD)***10.3 (2.5)2.6 (1.5)2015 ACR/EULAR criteria ≥8 points, N patients (%)***57 (90)0 (0)MSU crystal positive joint aspiration, N patients (%)44 (70)0 (0)DECT positive, N patients (%)49 (78)0 (0)* self-reported, intermittent symptoms; ** all patients classified with gout at baseline also had a clinical gout diagnosis after one yea; *** using a somewhat limited set, see methodsMTP, metatarsophalangeal joints; SUA, serum uric acid; DECT, dual-energy CT; MSU, monosodium urate;.Sensitivity, specificity, positive and negative predictive value, and accuracy values (95% CI) of the classification criteria set we used were 0.91 (0.80-0.96); 1 (0.63-1); 1; 0.57 (0.38-0.74) and 0.92 (0.83-0.97), respectively. The area under the receiver operating characteristics curve (95% CI) was 0.95 (0.91-0.99).ULT was started in 49/63 (78%) of gout patients; 45/49 (92%) of them had serum uric acid levels ≤ 360 μmol/l and no recurrent gout attack during one-year follow-up.Conclusion:The 2015 ACR-EULAR gout classification criteria performed well for the diagnosis gout in clinical practice. Most gout patients had been treated successfully, according to current guidelines.References:[1]Gamala M, Jacobs JWG, Linn-Rasker SF, Nix M, Heggelman BGF, Pasker-de Jong PCM, et al. The performance of dual-energy CT in the classification criteria of gout: a prospective study in subjects with unclassified arthritis. Rheumatology 2019 Sep (Epub ahead print).Disclosure of Interests:Mihaela Gamala: None declared, Johannes W. G. Jacobs Grant/research support from: Roche, Suzanne Linn-Rasker: None declared, Maarten Nix: None declared, Ben Heggelman: None declared, Pieternel Pasker: None declared, Jacob M. van Laar Grant/research support from: MSD, Genentech, Consultant of: MSD, Roche, Pfizer, Eli Lilly, BMS, Ruth Klaasen: None declared

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U-Shaped Relationship Between Functional Outcome and Serum Uric Acid in Ischemic Stroke

Cellular Physiology and Biochemistry ◽

10.1159/000491609 ◽

2018 ◽

Vol 47 (6) ◽

pp. 2369-2379 ◽

Cited By ~ 4

Author(s):

Yimin Yang ◽

Ying Zhang ◽

Yanhua Li ◽

Lili Ding ◽

Lulu Sheng ◽

...

Keyword(s):

Uric Acid ◽

Ischemic Stroke ◽

Functional Outcome ◽

Serum Uric Acid ◽

High Performance ◽

Unfavorable Outcome ◽

Chinese Patients ◽

Number Of Patients ◽

Consecutive Number

Background/Aims: We sought to assess a consecutive number of patients with first-ever acute ischemic stroke (AIS), the clinical relevance in regard to functional outcome of the serum uric acid (SUA) measured at admission. Methods: In 2 prospective centers for observational study, serum concentrations of SUA were measured on admission in the serum of 710 consecutive patients with AIS. SUA concentrations were determined by high-performance liquid chromatography. SUA, NIH stroke scale (NIHSS), and conventional risk factors were evaluated to determine their value to predict functional outcome within 3 months. Results: During the follow-up, an unfavorable functional outcome (defined as a mRS score > 2) was found in 219 (30.8%) patients. The unfavorable functional outcome distribution across the SUA quartiles ranged between 12.4% (third quartile) and 50.6% (first quartile). After adjusting for all other significant outcome predictors, SUA concentration remained an independent unfavorable outcome predictor with an adjusted OR of 0.996 (95% CI, 0.993-0.998; P< 0.001). Conclusions: The data show that the U-shaped nature of the exposure-risk relationship was more prominent when the data were assessed in deciles (based on the SUA values). This model predicted the lowest relative risk of unfavorable outcome in the 67th percentile (corresponding to 309 µmol/L). SUA was significantly associated with the risk of poor functional outcomes in Chinese patients with stroke.

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