Higher serum uric acid levels are associated with improved outcomes in acute ischemic stroke patients following intravenous thrombolysis with alteplase—a retrospective cohort study

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.