Association of Serum Uric Acid Level as a Risk Factor and Severity Marker With Acute Ischemic Stroke

TL;DR

Higher levels of serum uric acid are linked to more severe disability in patients with acute ischemic stroke, but the relationship is not causal.

Contribution

This study identifies serum uric acid as a marker of stroke severity and functional disability in acute ischemic stroke patients.

Findings

Elevated serum uric acid levels correlate strongly with increased stroke severity as measured by the Modified Rankin Scale.

Serum uric acid levels increase progressively with higher disability scores in acute ischemic stroke patients.

The association between serum uric acid and stroke disability is not causal or independent.

Abstract

Introduction

Stroke is a major global health burden and a leading cause of mortality. Serum uric acid (SUA) exhibits a dual biological role, acting as an antioxidant at physiological levels while contributing to oxidative stress and endothelial dysfunction when elevated. The association between SUA levels and stroke severity remains controversial. The study aimed to evaluate the association between serum UA levels and acute ischemic stroke and to assess its relationship with functional disability as measured by the Modified Rankin Scale (mRS).

Materials and methods

This observational cross-sectional study was conducted from June 2024 to December 2025. A total of 63 adult patients with radiologically confirmed acute ischemic stroke presenting within 48 hours of symptom onset were included. SUA levels were measured using the uricase method. Stroke severity was assessed using the mRS at admission. Data were analyzed using SPSS version 26. Comparison across mRS categories was performed using one-way analysis of variance (ANOVA), and correlation was assessed using Spearman’s rank correlation coefficient.

Results

The mean age of participants was 59.4±14.5 years, with male predominance (40; 63.5%). Hypertension (23; 36.5%) and diabetes mellitus (16; 25.4%) were the most common comorbidities. The mean SUA level was 8.0±1.5 mg/dL. Most patients had moderate disability, with 40 patients (63.5%) having an mRS score of 3 and 22 (34.9%) an mRS score of 4. Mean SUA levels increased progressively with stroke severity (p<0.0001). A strong correlation was observed between SUA levels and mRS scores (ρ=0.89, p<0.001).

Conclusion

Elevated SUA levels are associated with greater functional disability in patients with acute ischemic stroke at presentation. These findings indicate an associative relationship between SUA levels and stroke-related disability rather than a causal or independent prognostic role. Larger prospective studies are required to further clarify the clinical significance of this association.