Acil Servis Hastalarında Serum Ürik Asit Düzeyi ve İnme İlişkisinin Değerlendirilmesi

Year 2024, Volume: 26 Issue: 2, 112 - 117, 30.08.2024

Erdinç Şengüldür , Mehmet Cihat Demir

https://doi.org/10.18678/dtfd.1457023

Abstract

Amaç: İnme, sakatlık ve ölümlerin önde gelen nedenlerinden biridir. İnme yönetiminde klinik ve görüntüleme yöntemleri yaygın olarak kullanılırken, serum ürik asit (SUA) düzeyi gibi biyokimyasal parametreler büyük ölçüde göz ardı edilmektedir. Bu çalışmada, yüksek veya düşük SUA düzeyleri ile hem iskemik hem de hemorajik inme arasındaki ilişkinin incelenmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu çalışma retrospektif, tek merkezli gözlemsel bir çalışmadır. Çalışmaya 1 Ocak 2023 ile 31 Aralık 2023 tarihleri arasında acil servisten nöroloji ve/veya beyin cerrahisine konsülte edilen tüm ardışık hastalar dahil edilmiştir. Hastaların verileri hastane bilgisayar sisteminden ve acil servis kayıtlarından elde edilmiştir. ≤2,8 mg/dL olan SUA düzeyleri hipoürisemiyi gösterirken, ≥7 mg/dL olması hiperürisemi olarak kabul edildi.
Bulgular: Çalışmaya toplam 1186 yetişkin hasta dahil edildi. Bunların 484'ünün inme tanısı aldığı, 394'ünün iskemik inme, 90'ının ise hemorajik inme olduğu görüldü. İnme hastalarının medyan SUA düzeyleri daha yüksekti (p<0,001). İskemik inme hastalarının medyan SUA düzeyi hemorajik inme hastalarından daha yüksekti (p<0,001). Hiperürisemi iskemik inme riskini 2,4 kat artırmıştır (OR: 2,402; %95 GA: 1,792-3,221; p<0,001). Hipoürisemi iskemik inme riskini azaltmıştır (OR: 0,272; %95 GA: 0,129-0,577; p<0,001).
Sonuç: SUA düzeyleri inme ve iskemik inme ile ilişkilidir. Hiperürisemi, acil serviste olası inme tanısını güçlendiren ek bir parametre olarak yararlı olabilir. İnme açısından riskli hastaların SUA düzeyleri bu hastaların takibi ve planlanacak önlemler açısından faydalı olabilir.

Keywords

Acil Servis, inme, Ürik Asit

Evaluation of the Association of Serum Uric Acid Levels and Stroke in Emergency Department Patients

Abstract

Aim: Stroke is a leading cause of disability and fatality. While clinical and imaging methods are commonly used in stroke management, biochemical parameters such as serum uric acid (SUA) level are largely overlooked. This study aimed to examine the relationship between high or low SUA levels and both ischemic and hemorrhagic stroke.
Material and Methods: This is a retrospective, single-center observational study. The study included all consecutive patients who were consulted from the emergency department (ED) to neurology and/or neurosurgery between January 1, 2023, and December 31, 2023. Data of the patients were obtained from the hospital computer system and ED records. While SUA levels of ≤2.8 mg/dL indicated hypouricemia, levels of ≥7 mg/dL were considered hyperuricemia.
Results: A total of 1186 adult patients were included in the study. It was observed that 484 of them were diagnosed with stroke, 394 were ischemic stroke, and 90 were hemorrhagic stroke. Stroke patients had higher median SUA levels (p<0.001). The median SUA level of ischemic stroke patients was higher than hemorrhagic stroke patients (p<0.001). Hyperuricemia increased the risk of ischemic stroke 2.4-fold (OR: 2.402, 95% CI: 1.792-3.221, p<0.001). Hypouricemia decreased the risk of ischemic stroke (OR: 0.272, 95% CI: 0.129-0.577, p<0.001).
Conclusion: SUA levels are associated with stroke and ischemic stroke. Hyperuricemia may be useful as an additional parameter to strengthen the diagnosis of possible stroke in ED. SUA levels of patients at risk for stroke can be useful in terms of follow-up of these patients and the precautions to be planned.

Keywords

Emergency Department, Stroke, Uric Acid

References

• GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-80.
• Padda J, Khalid K, Padda S, Boddeti NL, Malhi BS, Nepal R, et al. Hyperuricemia and its association with ischemic stroke. Cureus. 2021;13(9):e18172.
• Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation. 2020;141(9):e139-e596.
• Wang A, Tian X, Zuo Y, Chen S, Mo D, Zhang L, et al. Effect of changes in serum uric acid on the risk of stroke and its subtypes. Nutr Metab Cardiovasc Dis. 2022;32(1):167-75.
• Lokkanahalli SS, Handargal NH, Papali MM, Subash N. Serum uric acid and lipid levels in patients with acute ischemic stroke: a cross-sectional study. Cureus. 2022;14(8):e28114.
• Chen J, Zhu Q, Yu L, Li Y, Jia S, Zhang J. Stroke risk factors of stroke patients in China: A nationwide community-based cross-sectional study. Int J Environ Res Public Health. 2022;19(8):4807.
• Liu CY, Hsiao CL, Chen PY, Tsou A, Tzeng IS, Lin SK. J-shaped relationship of serum uric acid with unfavorable short-term outcomes among patients with acute ischemic stroke. Biomedicines. 2022;10(9):2185.
• Sun P, Chen M, Guo X, Li Z, Zhou Y, Yu S, et al. Combined effect of hypertension and hyperuricemia on ischemic stroke in a rural Chinese population. BMC Public Health. 2021;21(1):776.
• Li M, Hou W, Zhang X, Hu L, Tang Z. Hyperuricemia and risk of stroke: a systematic review and meta-analysis of prospective studies. Atherosclerosis. 2014;232(2):265-70.
• Irfan M, Jawaid W, Hashmat O, Nisa Q, Khastoori DR 2nd, Shahbaz NN. Association between hyperuricemia and acute ischemic stroke in patients at a tertiary care hospital. Cureus. 2020;12(10):e10899.
• Crawley WT, Jungels CG, Stenmark KR, Fini MA. U-shaped association of uric acid to overall-cause mortality and its impact on clinical management of hyperuricemia. Redox Biol. 2022;51:102271.
• Kanda E, Muneyuki T, Kanno Y, Suwa K, Nakajima K. Uric acid level has a U-shaped association with loss of kidney function in healthy people: a prospective cohort study. PLoS One. 2015;10(2):e0118031.
• D'Silva KM, Yokose C, Lu N, McCormick N, Lee H, Zhang Y, et al. Hypouricemia and mortality risk in the US general population. Arthritis Care Res (Hoboken). 2021;73(8):1171-9.
• Miake J, Hisatome I, Tomita K, Isoyama T, Sugihara S, Kuwabara M, et al. Impact of hyper- and hypo-uricemia on kidney function. Biomedicines. 2023;11(5):1258.
• Matsuo H, Chiba T, Nagamori S, Nakayama A, Domoto H, Phetdee K, et al. Mutations in glucose transporter 9 gene SLC2A9 cause renal hypouricemia. Am J Hum Genet. 2008;83(6):744-51.
• Otani N, Hoshiyama E, Ouchi M, Takekawa H, Suzuki K. Uric acid and neurological disease: a narrative review. Front Neurol. 2023;14:1164756.
• Weisskopf MG, O'Reilly E, Chen H, Schwarzschild MA, Ascherio A. Plasma urate and risk of Parkinson's disease. Am J Epidemiol. 2007;166(5):561-7.
• Du N, Xu D, Hou X, Song X, Liu C, Chen Y, et al. Inverse association between serum uric acid levels and Alzheimer's disease risk. Mol Neurobiol. 2016;53(4):2594-9.
• Tu WJ, Wang LD; Special Writing Group of China Stroke Surveillance Report. China stroke surveillance report 2021. Mil Med Res. 2023;10(1):33.
• Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson CS, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019;18(4):394-405.
• Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke. 2022;17(1):18-29.
• Senguldur E, Selki K, Tuncer C, Demir MC. Emergency department neurosurgical consultations in a tertiary care hospital. Konuralp Med J. 2023;15(3):412-6.
• Miller J, Kinni H, Lewandowski C, Nowak R, Levy P. Management of hypertension in stroke. Ann Emerg Med. 2014;64(3):248-55.
• Cheng Z, Zheng T, Zhang D, Yang J, Hu X, Yin C, et al. High-level uric acid in asymptomatic hyperuricemia could be an isolated risk factor of cardio-cerebrovascular diseases: A prospective cohort study. Nutr Metab Cardiovasc Dis. 2021;31(12):3415-25.
• Singh JA, Yu S. Allopurinol and the risk of stroke in older adults receiving medicare. BMC Neurol. 2016;16(1):164.