Uric acid-to-albumin ratio and mortality in stroke patients: a DAQS-stratified analysis.

OBJECTIVES

The objectives of our study are to explore the associations of uric acid to albumin ratio (UAR) with all-cause and cardiovascular mortality in stroke patients, and to examine whether UAR-mortality associations differ between stroke patients stratified by dietary antioxidant quality score (DAQS).

METHODS

This cohort study included 1125 stroke patients from the NHANES 2007-2018. The DAQS was calculated based on the intake of six anti-oxidative nutrients. Multivariate Cox proportional hazards models were used to investigate the associations of UAR with all-cause and cardiovascular mortality in the total stroke cohort and within subgroups stratified by DAQS.

RESULTS

UAR showed a positive linear association with all-cause mortality in unadjusted and adjusted models (HR = 1.49, p = 0.003). For cardiovascular mortality, the association with continuous UAR was significant before but not after adjustment (HR = 1.43, p = 0.108). Compared with low UAR (≤1.34), high UAR (>1.34) was associated with higher all-cause (HR = 1.37, = 0.030) and cardiovascular mortality (HR = 1.64, p = 0.040). In exploratory DAQS-stratified analyses, elevated UAR was related to higher all-cause (HR = 1.58) and cardiovascular mortality (HR = 1.83; both p < 0.05) only among patients with low DAQS, whereas associations in the high-DAQS subgroup were generally non-significant and imprecise.

CONCLUSION

Higher UAR after stroke was robustly associated with increased all-cause mortality, with weaker and less consistent evidence for cardiovascular mortality. Exploratory DAQS-stratified analyses suggested excess risk with high UAR mainly among patients with low DAQS, while findings in the smaller high-DAQS subgroup were non-significant and imprecise; these subgroup and cardiovascular results are hypothesis-generating.