Serum uri acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study

SUA levels were obtained at admission and categorized as low, middle and high, based on 33° and 66° percentile values. Patients were categorized as patients admitted within 3 hours of symptom onset receiving rt-PA (rt-PA group), patients admitted within 3 hours of symptom onset not receiving rt-PA (non-rt-PA group), and patients admitted after time window for rt-PA (late group). Short-term clinical improvement was defined as the difference between NIHSS on admission minus NIHSS day 7. Favorable outcome was defined as mRS 0 - 3 and unfavorable outcome as mRS 4 - 6.SUA measurements were available in 1136 patients. Clinical improvement was significantly higher in patients with high SUA levels at admission. After adjustment for possible confounders, SUA level showed a positive correlation with clinical improvement (r = 0.012, 95% CI 0.002-0.022, p = 0.02) and was an independent predictor for favorable stroke outcome (OR 1.004; 95% CI 1.0002-1.009; p = 0.04) only in the rt-PA group.SUA may not be neuroprotective alone, but may provide a beneficial effect in patients receiving thrombolysis.Serum uric acid (SUA) is a final enzymatic product of purine metabolism [1,2]. Animal models of acute ischemic stroke (AIS) have shown that SUA may be neuroprotective [3] and may reinforce the benefits of intravenous thrombolysis (rt-PA) [4]. In humans, high SUA may be an independent predictor of better outcome after AIS [5] and represent a consumptive and reproducible antioxidant in AIS [6,7]. Combined intravenous administration of rt-PA and SUA is safe, prevents an early decline in SUA levels and decreases lipid peroxidation but has not shown any clinical effect [8]. On the other hand, high SUA levels have been also associated with hypertension [9], dyslipidemia, type 2 diabetes [10], kidney disease, cardiovascular and cerebrovascular events [11] and worse functional outcome after AIS [12]. The role of SUA in AIS is therefore still controversial, and a possible synergic role of SUA wi