Published: 2017-01-23

Evaluation of serum uric acid in acute ischaemic stroke

Inderjeet Kaur, Ashok Khurana, Jasmine Kaur Sachdev, Gurinder Mohan


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.


GCS, Stroke, Serum uric acid

Full Text:



Hariklia VD, Apostolos H, Haralambosk. The role of uric acid in stroke. the lssue remains unresolved. The Neurologist. 2008;14:238-42.

Feigin VL, Lawes CM, Bennett DA. Worldwide stroke incidence and early case fatality reported in 56 population- based studies: a systematic review. Lancet Neurol. 2009;8(4):355-69.

Love S. Oxidative stress in brain ischemia. Brain Pathol Zurich Switz.1999;9(1):119-31.

Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study 1971-1992. National Health and Nutrition Examination Survey. JAMA. 2000;283(18):2404-10.

Chamorro A, Obach V, Cervera A. Prognostic significance of uric acid serum concentration in patients with acute ischemic stroke. Stroke. 2002;33(4):1048-52.

Romanos E, Planas AM, Amaro S, Chamorro A. Uric acid reduces brain damage and improves the benfits of rtPA in a rat model of the thromboembolic stroke. J Cereb Blood Flow Metab. 2007;27(1):14-20.

Brouns R, Wauters A, Van D, Vijver G. Decrease in uric acid in acute ischemic stroke correlates with stroke severity, evolution and outcome. Clin Chem Lab Med. 2010;48(3):383-90.

Logallo N, Naess H, Idicula TT. Serum uric acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study. BMC Neurol. 2011;11:114.

Wang Z, Lin Y, Liu Y. Serum uric acid levels and outcomes after acute ischemic stroke. Mol Neurobiol. 2016;53(3):1753-9.

Yadav SK, Nepal N, Niroula D. Prevalence of hyperuricemia among people of morang district of nepal. Journal Nobel Medical College. 2014;3(6):16-21.

Uaratanawong S, Suraamornkul S, Angkeaw S, Uaratanawong R. Prevalence of hyperuricemia in Bangkok population. Clinical Rheumatology. 2011;30(7):887-93.

Milionis HJ, Kalantzi KJ, Goudevenos JA. Serum uric acid levels and risk for acute ischaemic non-embolic stroke in elderly subjects. J Intern Med. 2005;258(5):435-41.

Foerch C, Ghandehari K, Xu G, Kaul S. Exploring gender distribution in patients with acute stroke: A multi-national approach. J Res Med Sci. 2013;18(1):10.

Pearce J, Aziz H. Uric acid and plasma lipids in cerebrovascular disease. Prevalence of hyperuricaemia. Br Med J. 1969;4:78-80.

Mbenza B, Luila EL, Mbete P, Vita EK. Is hyperuricemiaa risk factor of stroke and coronary heart disease among Africans? Int J Cardiol. 1999;71(1):17-22.

Bos MJ, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM. Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study. Stroke. 2006;37(6):1503-07.

Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham heart study. Ann Intern Med. 1999;131(1):7-13.

Samuels MA, Feske S. Office practice of neurology. New York: Churchill Livingstone. 1996:224-237.

Cannon PJ, Stason WB, Demartini FE, Sommers SC, Laragh JH. Hyperuricemia in primary and renal hypertension. N Engl J Med. 1966;275(9):457-64.

Mazzali M, Hughes J, Kim YG. Elevated uric acid increases blood pressure in the rat by a novel crystal- independent mechanism. Hypertension. 2001;38:1101-6.

Lehto S, Niscanen L, Ronnemaa T, Laasko M. Serum uric acid is a strong predictor of stroke in patients with non-insulin dependent diabetes mellitus. Stroke. 1998;29(3):635-9.

Zhang X, Patel A, Horibe H. Wu Z. Asia pacific cohort studies colloboration. cholesterol, coronary artery disease and stroke in the Asia pacific region. Int J Epidemiol. 2003;32(4):563-72.

Horestein RB, Smith DE, Mosca L. Cholesterol predicts stroke mortality in the women’s pooling project. Stroke. 2002;33(7):1863-8.

Amarenco P, Labreuche J, Lavallee P, Touboul PJ. Statins in stroke prevention and carotid atherosclerosis: systematic review and metaanalysis. Stroke. 2004;35(4):2902-9.

Kargiannis A, Mikhalidis DP, Tziomalos K. Serum uric acid as an independent predictor of early death after acute stroke. Circ J. 2007;71:1120-7.

Gain MP, Xue YM, Shan J, Zhou L. Serum uric acid in type 2 diabetic patients complicated by stroke. 2002;22(1):70-1.

Shrikrishna R, Suresh DR. Biochemical study of antioxidant profile in acute ischemic stroke. British J Med Practitioners. 2009:2(1):35-7.

Kim SY, Guevara JP, Kim KM. Hyperuricemia and risk of stroke: a systematic review and metaanalysis. Arthritis Rheum. 2009;61(7):885-92.

Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and future vascular events after acute ischemic stroke. Stroke. 2003;34(8):1951-6.

Mozos I, Chiulana C, Goruna C, Costeab S. Serum uric acid in stroke. Annals Timisoara. 2007;16(2):227-36.

Abuja PM. Ascorbate prevents prooxidant effects of urate in oxidation of human low density lipoprotein. FEBS Lett. 1999;446:305-8.

Waring WS, Webb DJ, Maxwell SRJ. Effect of local hyperuricaemia on endothelial function in the human forearm vascular bed. Br J Clin Pharmacol. 2000;49:511.

Berry C, Hamilton CA, Brosnan MJ. Investigation into the sources of superoxide in human blood vessels: angiotensin II increases superoxide production in human internal mammary arteries. Circulation. 2000;101(18):2206-12.

Westing HY. Immuno histochemical localization of xanthine oxidase in human cardiac and skeletal muscle. Histochemistry. 1993;100(3):215-22.

Muir SW, Harrow C, Dawson J. Allopurinol use yields potentially beneficial effects on inflammatory indices in those with recent ischemic stroke: a randomized, double-blind, placebo-controlled trial. Stroke. 2008;39(12):3303-7.

Hayden MR, Tyagi SC. Uric acid: a new look at an old risk marker for cardiovascular disease, metabolic syndrome and type 2 diabetes. Nutrition and metabolism. 2004;1:10.

Milionis HJ, Elisaf MS. Management of hypertension and dyslipidaemia in patients presenting with hyperuricaemia: case histories. Curr Med Res Opin. 2000;16(3):164-70.

Morag KN, Goldbourt U, Tanne D. Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease. Stroke. 2005;36(7):1366-71.

Hoieggen A, Alderman MH, Kjeldsen SE. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int. 2004;65(3):1041-9.

Athyros VG, Elisaf M, Papageorgiou AA. Effect of statins versus untreated dyslipidaemia on serum uric acid levels in patients with coronary heart disease: a subgroup analysis of the GREek atorvastatin and coronary-heart-disease evaluation (GREACE) Study. Am J Kidney Dis. 2004;43(4):589-99.