Xiangpen Li

Background: Emerging evidence suggests that hyperuricemia may serve as a predictor of favorable outcomes in acute ischemic stroke (AIS) patients receiving endovascular treatment; however, the relationship between serum uric acid (SUA) levels and clinical outcomes in AIS patients treated with intravenous thrombolysis (IVT) remains underexplored. Methods: In this retrospective study, we analyzed AIS patients who underwent IVT with alteplase within 4.5 h of symptom onset, excluding those undergoing subsequent endovascular intervention, at our hospital between November 2021 and December 2024. Data collection encompassed baseline demographic and clinical characteristics, SUA levels measured within 24 h post-thrombolysis, and neuroimaging findings from cranial computed tomography and magnetic resonance scans. The primary outcome was defined as an excellent 90-day functional outcome, characterized by a modified Rankin Scale (mRS) score of 0–1. Results: Among 194 screened patients, 130 were included in the final analysis. Of these, 87 patients (66.92%) achieved an excellent 90-day outcome. Multivariable logistic regression analysis, adjusted for potential confounders, revealed that patients with higher SUA levels (>360 μmol/L) exhibited a significantly higher likelihood of achieving an excellent 90-day outcome (adjusted OR: 2.690, 95% CI: 1.082–6.685, p = 0.033) and a favorable 90-day outcome (mRS 0–2) (adjusted OR: 4.271, 95% CI: 1.438–12.686, p = 0.009) compared to those with normal SUA levels. No significant association was observed between SUA levels and the incidence of intracranial hemorrhage or 90-day mortality ( p > 0.05). Conclusion: These findings indicate that higher SUA levels are significantly associated with improved 90-day functional outcomes in AIS patients treated with alteplase thrombolysis within 4.5 h of symptom onset.