Study On The Correlation Of Serum Uric Acid And Hospital Outcome Of Acute Cerebral Infarction

Objection:To observe the distribution characteristics and to explore the association of uric acid levels among the acute cerebral infarction patients at admission and discharge in order to provide a better control range for the prevention, treatment and rehabilitation for the patients and provide a reference for the in-depth study of the relationship between uric acid and cerebral infarction.Method: By a way of retrospective investigation, using a self-made questionnaire of risk factors of cerebral infarction, collect the data of acute cerebral infraction patients in Neurology Department from the Affiliated Hospital of North Sichuan Medical College and medical records of Nanchong Central Hospital from March, 2012 to May, 2014 including demographic characteristics, medical history, biochemical indexs, the grades of NIHSS and MRS. The grades of MRS and NIHSS have two separate hospital outcomes at discharge, poor outcome is defined as MRS≥3 or NIHSS≥5, good outcome is MRS<3 or NIHSS<5. SPSS17.0 software is used for statistical analysis; LSD-t test is used in the pairwise comparison within the group, single factor analysis of variance is used between groups. Differences of risk factors in uric acid levels are compared. Based on the outcome at discharge, The odds rations of value of different risk factors of cerebral infarction and 95%CI are calculated respectively using non conditional logistic regression analysis method. calculate the odds ration(OR) and 95% confidence interval(95%CI) of with different risk factors and the range of uric acid and poor outcome at discharge are calculated according to quntile of uric acid level. The results are both P<0.05 having statistical significance.Results: 1. Among 2 019 acute cerebral infraction patients, 1 188 patients are males, 831 are females, the rate of males(58.84%) are higher than that of females. Among the patients, 360 had a history of diabetes, 89 having heart disease, 1 447 having hypertension, 473 having recurrent cerebral infraction, 1 019 having dyslipidemia. When evaluated with the score of MRS at discharge, the number of good outcome is 1 057, poor outcome is 962, the percentage of good outcome is higher(52.35%) than that of poor outcome(47.65%). When evaluated with the score of NIHSS at discharge, the number of good outcome is 1 225, poor outcome is 794, the percentage of good outcome is also higher(60.62%) than that of poor outcome(39.38%).2. Adopting the LSD-t test and grouping the patients according to the risk factors(with or without), the uric acid levels are compared. The results are as follows: the uric acid levels of the group of males, recurrent cerebral infraction, non-diabetes, dyslipidemia and good outcome at discharge are higher than those of the control groups, P<0.05.3. With the hospital outcome as the basis, we discover that hospital outcome is connected with gender, history of heart disease and cerebral infraction, age, WBC, MPV, INR, PT%, FIB, CRP, GLU and UA, P<0.05. Using unconditioned Logistic regression analysis method, the data show that age, history of heart disease, WBC, UA are connected with the hospital outcome after multivariate-adjusted OR,P<0.05, and the OR of UA is less than 1.4. Divide the patients according to the UA level into five groups and compare the outcome OR(95%CI) at discharge(≤228.80μmol/L,228.81-278.00μmol/L,278.01-319.20μmol/L,319.21-379.70μmol/L,≥379.71μmol/L). Take the first group as the reference group, OR(95%CI) of poor outcome(the score of MRS) are 1.000, 0.627(0.475, 0.827), 0.563(0.425, 0.744), 0.546(0.413, 0.722), 0.623(0.471, 0.822), P<0.05; and the score of NIHSS are 1.000, 0.718(0.544, 0.949), 0.608(0.458, 0.806), 0.551(0.415, 0.732), 0.550(0.414, 0.731), P<0.05, they all show a u-shaped relationship between uric acid and poor outcome. UA are further divided into quintile according to the gender(males:≤252.96μmol/L, 252.97-295.46μmol/L,295.47-341.00μmol/L,341.01-398.7μmol/L, ≥398.73μmol/L;females:≤202.16μmol/L, 202.17-249.00μmol/L,249.01-291.62μmol/L,291.63-336.00μmol/L,≥336.01μmmol/L).Using the same statistical analysis method and take the first group as the control group, OR(95%CI) of poor outcome(the score of MRS) for males are 1.00, 0.576(0.401, 0.829), 0.568(0.395, 0.816), 0.449(0.310, 0.649), 0.581(0.404, 0.835),and the score of NIHSS are 1.00, 0.832(0.576, 1.201), 0.618(0.425, 0.900), 0.471(0.319, 0.694), 0.720(0.497, 1.044); OR(95% CI) of poor outcome(the score of MRS) for females are 1.000, 0.683(0.442, 1.056), 0.530(0.343, 0.821), 0.606(0.392, 0.936), 0.852(0.550, 1.321),and the score of NIHSS are 1.000, 0.580(0.376, 0.896), 0.601(0.390, 0.928), 0.539(0.349, 0.833), 0.608(0.394, 0.938), P<0.05. They also show a U-shaped relationship respectively in males and females.Conclusion:1. The level of serum uric acid and the outcome of the patients with acute cerebral infarction at discharge showed a U-shaped relationship, namely, too low or too high of the level of serum uric acid will both increase the poor outcome; the lowest level of uric acid is a predicative factor of the good hospital outcome in acute cerebral infraction. In the prevention of cerebral infarction the normal blood uric acid range may change.2.The outcome at discharge showed age differences, namely, age is a risk factor for hospital outcomes in patients with acute cerebral infarction.3. WBC increase at admission can be a predictor of poor outcome at discharge.4. The history of heart disease and the recurrence of cerebral infarction will increase the risk of poor outcomes at discharge.