The prognostic significance of uric acid to albumin ratio in patients with aneurysmal subarachnoid hemorrhage following surgical clipping or endovascular interventions: insights from a large cohort study.

Background: An increasing number of studies find uric acid to albumin ratio (UAR) plays an important role in predicting prognosis of cardiovascular disease. Nevertheless, the clinical significance of UAR in aneurysmal subarachnoid hemorrhage (aSAH) is unclear. This study aims to investigate the correlation between UAR and prognosis of aSAH. Methods: In this research, we retrospectively reviewed data of aSAH patients based on the LongTEAM registry. The primary endpoint is the functional outcome at 90 days after discharge and the secondary endpoint is the postoperative complications. Modified Rankin scale (mRS) was used to evaluate the functional outcome (mRS 0-2 was defined as favorable outcome and mRS 3-6 was defined as unfavorable outcome). Multivariate logistic regression was applied to evaluate the association between UAR and prognosis of aSAH. Receiver operating characteristic (ROC) curve was used to explore the predictive ability of UAR. Finally, patients were categorized into four groups based on the quartiles of UAR, and the association between UAR and in-hospital complications was assessed using multivariate logistic regression analysis. Results: A total of 937 patients were included in this study. After adjusting potential covariates, multivariate logistic regression showed that UAR was an independent risk factor of poor prognosis (OR (95%CI): 1.317 (1.235-1.405), p < 0.001). Furthermore, compared with reference quartile, patients in Q4 (UAR > 5.348) had a higher risk of postoperative major adverse cardiovascular events (OR (95%CI): 1.930 (1.286-2.898), p = 0.002), and postoperative pneumonia (OR (95%CI): 1.873 (1.210-2.898), p = 0.005). The ROC curve showed UAR had a satisfactory predictive performance (area under curve = 0.704). Conclusion: Elevated UAR levels were associated with high risk of unfavorable clinical outcomes, postoperative major adverse cardiovascular events, and pneumonia. UAR might be a simple, reliable, and cost-effective predictive marker for prognosis of aSAH. Clinical trial registration: https://clinicaltrials.gov/study/NCT04785976, NCT04785976.