# To Study the Effects of Metabolic Markers Sodium, Uric Acid, and Homocysteine in Stroke Patients and Their Correlation With In-Hospital Mortality

## TL;DR

This study finds that low sodium levels in stroke patients are strongly linked to higher in-hospital death rates, while uric acid and homocysteine are not, in an Indian patient group.

## Contribution

The study identifies hyponatremia as a novel independent predictor of in-hospital mortality in Indian stroke patients, offering a region-specific insight into stroke prognosis.

## Key findings

- Hyponatremia was strongly associated with in-hospital mortality (p < 0.001) in stroke patients.
- Uric acid and homocysteine levels did not show significant associations with mortality.
- Seasonal variation had no significant impact on stroke outcomes in the study region.

## Abstract

Background

Globally, stroke continues to rank among the foremost contributors to mortality and long-term disability, with a growing burden in India. Beyond traditional vascular risk factors, metabolic markers, such as serum sodium, uric acid, and homocysteine, have been implicated in stroke outcomes, but their prognostic role in Indian patients is unclear.

Objective

This study’s objectives are to determine the prognostic significance of serum sodium, uric acid, and homocysteine levels in patients with ischemic and hemorrhagic stroke in relation to in-hospital mortality and to evaluate the modifying influence of common comorbidities and seasonal variation on these outcomes.

Methods

At a New Delhi tertiary care hospital, 236 consecutive stroke patients (182 ischemic, 54 hemorrhagic) were recruited for a hospital-based study between November 2022 and November 2023. CT/MRI confirmed diagnosis. Demographics, comorbidities, and laboratory values (sodium, uric acid, and homocysteine) were gathered, and logistic regression and the chi-square test were used to look at their relationships with in-hospital mortality.

Results

Hyponatremia was observed in 90 patients (38.1%) and demonstrated a substantial correlation (p < 0.001) with a higher rate of in-hospital death. Out of the total 236 patients, 28 (11.9%) died during hospitalization. Among these, 21 patients (75%) had documented hyponatremia, while seven patients (25%) maintained normal sodium levels. Conversely, 69 patients with hyponatremia (76.7%) recovered and were discharged without mortality. The chi-square test revealed a strong association between hyponatremia and in-hospital mortality (χ² = 23.84, p < 0.001), confirming that reduced serum sodium significantly increased the risk of death. In contrast, hyperuricemia (22 patients, 9.3%) and hyperhomocysteinemia (144 patients, 61%) showed no significant associations with mortality (χ² = 1.37, p = 0.24 and χ² = 0.98, p = 0.32, respectively). Diabetes (120 patients, 50.8%) and hypertension (53 patients, 22.4%) were the most common comorbidities, but did not independently predict outcomes. Seasonal analysis revealed that ischemic strokes were slightly more frequent in winter (107 cases, 45.3%) compared to summer (93 cases, 39.4%), while hemorrhagic strokes were evenly distributed across seasons (30 in winter, 24 in summer). Mortality was marginally higher in winter (13 deaths, 5.5%) than in summer (10 deaths, 4.2%), but this difference was not statistically significant (χ² = 0.63, p = 0.459). These results suggest that mild climatic variation in the Delhi region did not exert a notable influence on short-term stroke outcomes, possibly due to consistent hospital care and limited temperature extremes across the study period.

Conclusion

Hyponatremia was independently linked to in-hospital mortality, whereas uric acid and homocysteine were not, in this Indian stroke cohort. By simultaneously evaluating multiple metabolic markers together with comorbidities and seasonal influences, this study offers a broader and region-specific perspective on stroke prognosis. The findings highlight hyponatremia as a simple, inexpensive marker for risk stratification and emphasize the need for multicenter longitudinal research to determine whether its correction improves survival.