ORIGINAL RESEARCH article
Front. Neurol.
Sec. Epilepsy
U-shaped association between serum uric acid at admission and post-stroke epilepsy in patients with ischemic stroke: a cohort study
Dayuan Liu 1
Hao Peng 2,3
Yihao Zhai 1
Muyao Wang 4
Hongli Jiang 1
Baoshou Su 1
Yunxiang Zhong 1
Guolong Deng 1
Ning Li 1
Jigao Feng 1
Caicai Zhang 4
1. Second Affiliated Hospital of Hainan Medical University, Haikou, China
2. Hainan Affiliated Hospital of Hainan Medical University, Haikou City, Hainan Prov, China
3. The Second People’s Hospital of Hainan Province, Wuzhishan, Hainan, China
4. Hainan Medical University, Haikou, China
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Abstract
Background: The relationship between serum uric acid (SUA) and post-stroke epilepsy (PSE) remains uncertain. We investigated the association between serum uric acid at admission and PSE after acute ischemic stroke. Methods: A retrospective cohort study was conducted on 21,459 ischemic stroke patients. Serum uric acid at admission was measured as part of routine laboratory testing and analyzed in quartiles (Q1-Q4). Logistic regression models with restricted cubic splines (RCS) were used to investigate the potential nonlinearity of the association between serum uric acid (SUA) levels and the risk of post-stroke epilepsy (PSE), with adjustments for demographic, clinical, and laboratory variables. Propensity score matching (PSM) was additionally employed to address potential confounding. Results: A U-shaped association was observed. Compared with the mid-range (Q2–Q3: ~305.3–373.9 μmol/L), both low (Q1) and high (Q4) SUA were associated with higher PSE risk (adjusted OR 2.32, 95% CI 1.79–2.99; and 1.60, 95% CI 1.26–2.02). RCS identified an inflection point around 335 μmol/L: below this level, higher SUA related to lower PSE risk, whereas above it, higher SUA related to higher risk. Findings were robust in propensity score–based and sensitivity analyses. Conclusion: SUA shows a U-shaped association with PSE after ischemic stroke. SUA levels within an intermediate range were associated with a lower risk of PSE. This observation is hypothesis-generating and requires confirmation in prospective studies to evaluate potential causal relationships.
Summary
Keywords
Inflammation, ischemic stroke, Oxidativestress, Post-stroke epilepsy, Serum uric acid, U-shaped association
Received
03 December 2025
Accepted
21 January 2026
Copyright
© 2026 Liu, Peng, Zhai, Wang, Jiang, Su, Zhong, Deng, Li, Feng and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jigao Feng
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