Stroke is a major neurological disorder and remains one of the leading causes of death and long-term disability worldwide. It continues to represent a significant public health concern across many countries. The impact of stroke is particularly pronounced in low- and middle-income nations such as India, where the rising prevalence of vascular risk factors and limitations in healthcare resources contribute substantially to disease burden.1 Stroke often results in persistent neurological deficits, functional disability, and considerable social and economic consequences affecting patients, families, and healthcare systems. According to the World Health Organization (WHO), stroke is defined as the rapid development of clinical signs indicating focal or global impairment of cerebral function that persists for more than 24 hours or results in death, with no apparent cause other than a vascular origin.1

 Based on the underlying pathophysiological mechanism, stroke can be broadly divided into two principal categories: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when cerebral blood flow is reduced or completely obstructed, most commonly due to thrombosis or embolism within cerebral arteries, leading to ischemia and subsequent neuronal damage. In contrast, hemorrhagic stroke occurs due to rupture of intracranial blood vessels, resulting in bleeding into the brain parenchyma or surrounding spaces. Among these two forms, ischemic stroke constitutes the majority of cases and accounts for nearly 80–85% of all strokes globally.²

  Over recent decades, the global burden of stroke has risen considerably. Several factors contribute to this increasing trend, including aging populations, rapid urbanization, sedentary lifestyle patterns, and a growing prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, obesity, and tobacco use. According to the Global Burden of Disease Study 2021, stroke remains the second leading cause of mortality worldwide and the third leading cause of disability-adjusted life years (DALYs).³ These observations highlight the significant impact of stroke on global health and underscore the importance of effective preventive strategies, timely diagnosis, and appropriate management to reduce associated morbidity and mortality.4

 In India, community-based studies have reported a crude prevalence of stroke ranging from 84 to 262 cases per 100,000 population.5-6 Both the incidence and prevalence of stroke are reported to be higher in urban regions compared to rural areas. This difference is largely attributed to the higher prevalence of conventional vascular risk factors in urban populations, including hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, and alcohol consumption.7

Aim

To evaluate the serum uric acid levels in acute stroke patients and to assess its clinical significance.

Objectives

• To estimate the serum uric acid levels in individuals presenting with acute stroke.
• To examine the association between serum uric acid concentration and the type of stroke, specifically ischemic and hemorrhagic stroke.
• To analyze the relationship between levels of serum uric acid and the stroke severity at presentation.

To evaluate the potential role of serum uric acid as a biomarker in patients with acute stroke.

Study Design

Cross-Sectional Observational Study.

The current study was conducted as a hospital-based cross-sectional observational investigation. It aimed to determine the serum uric acid levels in patients presenting with acute stroke and to analyze their association with established cerebrovascular risk factors.

 This research was conducted in the Department of General Medicine at Hassan Institute of Medical Sciences, Hassan,after taking institutional ethical clearance ,in which functions as a tertiary care teaching hospital. Patients admitted with clinical features suggestive of acute stroke were assessed and enrolled in the study after fulfilling the predefined inclusion and exclusion criteria. Data for this study were collected over a twelve-month period between March 2024 and February 2025.

 Patients admitted to the Department of General Medicine with a diagnosis of acute stroke during the study period were included in this study. Stroke diagnosis was based on the World Health Organization (WHO) criteria and was further confirmed through neuroimaging. A computed tomography (CT) scan of the brain was performed to verify the diagnosis and to distinguish between ischemic and hemorrhagic stroke.

Sample Size

The final study sample consisted of 150 patients who fulfilled the predefined eligibility criteria.

Inclusion Criteria

• Patients with acute stroke as defined by WHO criteria
• Age more than 18 years and less than 80 years
• Patients of either sex were eligible for inclusion in the study.
• Patients, or their legally authorized representatives, who were willing to provide written informed consent.

Exclusion Criteria

• Patients taking drugs known to cause hyperuricemia, such as:
• Loop diuretics
• Anticancer drugs
• Antitubercular therapy (Pyrazinamide, Ethambutol)
• Pentamidine
• Theophylline
• Ketoconazole
• Levodopa
• Isotretinoin
• Patients with gout
• Patients with history of chronic alcoholism
• Patients with previous history of coronary vascular events

Methodology

Written informed consent was obtained prior to enrolment. Individuals presenting with acute stroke who satisfied the predefined inclusion and exclusion criteria were subsequently recruited, resulting in a total sample of 150 participants.

For each participant, a detailed clinical history was documented with special attention to established cerebrovascular risk factors such as hypertension, diabetes mellitus, smoking habits, alcohol intake, and other relevant comorbid conditions. This was followed by a thorough general physical examination and a comprehensive neurological assessment.

Laboratory Investigations

Determination of serum uric acid concentration was carried out for all participants using a standard enzymatic technique at the central laboratory of Hassan Institute of Medical Sciences. Venous blood specimens obtained under aseptic conditions were processed according to established laboratory protocols. Quantitative estimation of uric acid was performed using the uricase–peroxidase enzymatic method, a widely accepted technique for serum uric acid analysis.

 Along with uric acid estimation, additional laboratory investigations were conducted to identify associated metabolic and systemic risk factors. These investigations included

• Blood urea
• Serum creatinine
• Lipid profile
• Fasting blood glucose
• Glycated hemoglobin (HbA1c)
• Complete blood count

All biochemical analyses were carried out in the institutional central laboratory following standard laboratory procedures. The collected data were systematically recorded and later analyzed to determine the association between serum uric acid concentration and various clinical and biochemical variables among patients diagnosed with acute stroke.

Table 1: Distribution of stroke type in the study population

Among the 150 participants, 120 (80.0%) had ischemic stroke and 30 (20.0%) had hemorrhagic stroke. Thus, ischemic stroke was the most common type observed in the study population.

Table 2: Association between hyperuricemia and type of stroke

The association between serum uric acid status and type of stroke was evaluated in the study population. Among the 120 patients with ischemic stroke, 94 patients (78.3%) had hyperuricemia, whereas 26 patients (21.7%) had normal serum uric acid levels. In contrast among the 30 patients with hemorrhagic stroke, only 8 patients (26.7%) had hyperuricemia, while 22 patients (73.3%) had normal uric acid levels.

Chi-square test: χ² = 27.11

p-value: < 0.001

Hyperuricemia was observed more frequently among patients with ischemic stroke compared to those with hemorrhagic stroke. Statistical analysis showed a significant association between hyperuricemia and ischemic stroke. 

Table 3: Comparison of mean serum uric acid levels between ischemic and hemorrhagic stroke

The mean serum uric acid level in individuals with ischemic stroke was 8.82 ± 2.75 mg/dL, while those with hemorrhagic stroke had a mean value of 6.68 ± 2.77 mg/dL. Independent sample t-test analysis showed a statistically significant difference between the two groups (p = 0.0004).

The present investigation aimed to assess the association between serum uric acid levels and acute stroke, as well as its relationship with various cerebrovascular risk factors and metabolic parameters. Stroke continues to be a major contributor to morbidity and mortality worldwide. Identification of biochemical markers that may influence stroke risk could contribute to improved risk assessment and preventive strategies.8 In recent years, serum uric acid has attracted considerable research interest because of its possible involvement in the development of cardiovascular and cerebrovascular disorders.

This hospital-based cross-sectional study involved 150 individuals diagnosed with acute stroke who were admitted to Hassan Institute of Medical Sciences. Participants were evaluated in detail with respect to demographic characteristics, clinical features, and established vascular risk factors including hypertension, diabetes mellitus, smoking status, and body mass index. The diagnosis of stroke was confirmed using neuroimaging, and the severity of neurological impairment at admission was assessed using standard clinical scoring systems.9

 Serum uric acid concentration was measured for all participants, and the pattern of uric acid levels among individuals with stroke was analyzed. The relationship between serum uric acid levels and different stroke types was also examined. In addition, correlations between uric acid levels and metabolic parameters such as lipid profile, glycated hemoglobin, and body mass index were evaluated to explore possible metabolic associations.10

The results obtained in this investigation were compared with previously published studies in order to better understand the role of serum uric acid in acute stroke. Several earlier investigations have examined the involvement of uric acid in cerebrovascular disease; however, their findings have been variable.11 While some studies have reported a strong link, others have described weaker or inconsistent relationships.

 In this investigation, elevated serum uric acid levels were observed more frequently among individuals with ischemic stroke. Patients with ischemic stroke showed higher uric acid concentrations compared with those experiencing hemorrhagic stroke. These observations are consistent with findings from several earlier studies that have also reported increased serum uric acid levels in individuals with ischemic stroke.

 A study by Kim et al. (2009)12 reported that higher serum uric acid concentrations were linked with an increased likelihood of stroke as well as stroke-related mortality. The authors proposed that hyperuricemia may promote vascular injury through mechanisms such as oxidative stress and endothelial dysfunction.³¹ The findings obtained in this investigation are in agreement with these observations, as higher uric acid levels were more commonly observed in individuals with ischemic stroke.

Comparable results were reported by Milionis et al. (2005), who observed that elevated serum uric acid concentrations were frequently present in patients with acute ischemic stroke and were related to unfavourable vascular outcomes. The investigators suggested that uric acid may serve as an indicator of underlying cardiovascular risk and metabolic disturbances.13.

 Similar observations have also been reported in studies conducted in India. Patil et al. (2011) observed that individuals with ischemic stroke had significantly higher serum uric acid levels compared with healthy control subjects, suggesting that hyperuricemia may represent an important biochemical factor related to cerebrovascular disease.14

This investigation was undertaken to explore the role of serum uric acid in acute stroke and to examine its relationship with demographic, clinical, and metabolic factors. The findings showed that increased uric acid concentrations were frequently observed among individuals diagnosed with acute stroke.

 Ischemic stroke accounted for the majority of cases in the study population. Individuals with ischemic stroke showed noticeably higher uric acid concentrations when compared with those experiencing hemorrhagic stroke. Statistical analysis indicated a significant relationship between hyperuricemia and ischemic stroke, suggesting that increased uric acid levels may be related to the occurrence of ischemic cerebrovascular events

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