Relationship Between Serum Uric Acid And Erythrocyte Volume Heterogeneity In Patients With Acute Ischemic Stroke

Objective: U-shaped association between serum uric acid(SUA)and pathogenesis and functional outcome has been found in acute ischemic stroke(AIS).However,whether SUA affects the size of red blood cell volume and changes the morphology of red blood cells in AIS is unclear.This study aimed to determine the relationship between SUA and red blood cell volume distribution width(RDW)in AIS patients.Methods: The baseline and biochemical data of 438 AIS patients diagnosed in the first affiliated Hospital of Dali University and Baoshan Branch of Renji Hospital affiliated to Medical College of Shanghai Jiaotong University from January 2018 to December 2018 were collected.SUA and RDW,a biochemical parameter that reflects the heterogeneity of red blood cell volume,were evaluated on admission.We evaluated the association between SUA and RDW through linear curve fitting analyses and two-piecewise regression analyses.Results: 1、Before adjusting for potential confounders,the association between serum SUA levels and RDW followed a U-shape in all patients.In female,the values of RDW significantly decreased with the increment of serum SUA(per mg/d L: β,-1.45;95%CI:-2.15～-0.75,p<0.001)in patients with SUA<3.86 mg/d L,and increased with the increment of SUA(per mg/d L: β,0.60;95%CI: 0.22～ 0.97,p=0.002)in patients with serum SUA≥3.86 mg/d L.Similar results were observed in male with the values of RDW significantly decreased with the increment of serum SUA(per mg/d L: β,-0.84;95%CI:-1.23～-0.45,p<0.001)in patients with SUA<4.82mg/d L,and increased with the increment of SUA(per mg/d L: β,0.29;95%CI: 0.04～ 0.53,p=0.026)in patients with serum SUA≥4.82 mg/d L.2 、 After adjusting for Age,Hypertension,Coronary heart disease,Platelets,Neutrophils,Fasting blood glucose,ESR,Prothrombin time,Creatine,Albumin,Lipid-lowering drugs and Antiplatelet drugs,the turning point of SUA were 3.96 mg/d L and 4.82 mg/d L in women and men,respectively,and the U-shaped association between SUA and RDW was maintained in women,the values of RDW significantly decreased with the increment of SUA(per mg/d L: β,-0.89;95%CI:-1.51～-0.28,p=0.005)in patients with SUA<3.96 mg/d L,and increased with the increment of SUA(per mg/d L: β,0.45;95%CI: 0.06～ 0.84,p=0.025)in patients with serum SUA≥3.96 mg/d L.In male,the values of RDW significantly decreased with the increment of SUA(per mg/d L: β,-0.77;95%CI:-1.18～-0.36,p<0.001)in patients with SUA<4.82 mg/d L,but no statistical significance maintained in patients with SUA≥4.82 mg/d L in men(p=0.206).Conclusion: In this sample of AIS patients,we found a U-shape relationship between serum SUA levels and RDW,with the turning point of SUA was 3.96 mg/d L in female and 4.82 mg/d L in male by threshold effect analysis.This study emphasizes the importance of maintaining the optimal level of SUA for the prevention of AIS,and has a certain guiding significance for the clinical treatment and prevention of recurrence of AIS.