Relationship of admission uric acid to high density lipoprotein cholesterol ratio with unfavorable prognosis among acute ischemic stroke patients.

BACKGROUND: Acute ischemic stroke (AIS) remains a major determinant for both mortality and enduring functional impairment. High density lipoprotein cholesterol (HDL) and Uric acid (UA) have opposing effects on oxidative stress and vascular protection. The UA/HDL ratio (UHR) may reflect systemic oxidative-lipid imbalance. This study examined whether admission UHR is linked to unfavorable prognosis among individuals with AIS. METHODS: Between October 2022 and September 2024, 822 consecutive AIS patients admitted to Bethune Hospital of Shanxi were retrospectively analyzed. Inclusion required first-ever AIS confirmed by imaging findings within 72 h. The principal endpoint was the functional status assessed at 90 days. Baseline demographics, clinical features, and laboratory values were collected. To account for confounding factors, the association of UHR with outcomes was analyzed through restricted cubic spline (RCS) models, multivariable logistic regression and subgroup analyses. RESULTS: Among 822 patients, 262 (31.9%) had unfavorable outcomes. These patients exhibited higher UA, lower HDL, and elevated UHR. Multivariable analysis confirmed that UHR was independently associated with unfavorable outcomes (adjusted OR: 1.0021; P = 0.0013). Membership in the top UHR quartile conferred an approximately twofold higher risk compared with the bottom quartile (adjusted OR = 1.97). RCS models demonstrated a linear positive association, with consistent findings across subgroups defined by stroke severity, sex, smoking, alcohol use, hypertension, and diabetes. CONCLUSIONS: Admission UHR is independently linked to unfavorable prognosis among individuals with AIS and holds promise as a simple, economical tool for early risk stratification and personalized management. Its use could support timely interventions and personalized management, contributing to improved patient outcomes and efficient allocation of healthcare resources. Prospective research is needed to validate its prognostic value and guide targeted interventions.