Association of UA levels with the risk of severe CED in LVO-AIS patients after mechanical thrombectomy

Abstract

Abstract Background Severe cerebral edema (CED) increases the poor prognosis and mortality rate of acute ischemic stroke (AIS) and reduces the benefit of intravascular therapy. Uric acid (UA) has been reported to possess a potential protective effect against AIS. The aim of our study was to explore the association between UA and severe CED after intravascular therapy. Method We conducted a retrospective cohort study of patients with large vascular occlusion acute ischemic stroke (LVO-AIS) who underwent endovascular thrombectomy (EVT) and had an mTICI grade of 2b-3 after EVT. A total of 272 LVO-AIS patients who accepted EVT were enrolled in the final study. All patients were divided into two groups according to the degree of CED: severe CED (N = 97) and mild CED (N = 175).UA levels at admission and imaging data at 24–48 h were collected. Baseline characteristics were compared using the chi-squared test, analysis of variance, or Mann-Whitney U-test. To examine the relationship between UA levels and CED, severe CED was estimated by modelling UA as a categorical variable using conditional logistic regression. Stratified analyses based on important covariates were conducted to explore possible protective factors. Result The UA levels were inversely associated with severe CED after adjustment for potential confounders (adjusted odds ratio [aOR], 1.00; 95% confidence interval [CI]: 0.99-1.00; p = 0.025). Participants with UA ≥ 360 µmol/L had a significantly lower risk of severe CED than participants with UA < 360 µmol/L when UA levels were categorized by clinical cut-off point (aOR, 0.48; 95% CI, 0.24–0.96; p = 0.039). The inverse association between UA and severe CED was significantly stronger in participants with lower blood glucose levels (< 7.5 mmol/L) compared with those higher blood glucose levels (≥ 7.5 mmol/L) (aOR, 0.21;95% CI, 0.07-0.62l; p for interaction = 0.021). Conclusion UA may be a potential protective factor against severe CED in LVO-AIS patients receiving EVT. Further more, the protective effect may be enhanced by lower blood glucose levels compared to higher blood glucose levels.