Urine ketone bodies and adverse outcomes in patients with acute ischemic stroke or TIA

Background and aims: Urine ketone bodies have been considered as predictors of stroke in diabetic patients, however, the role of urine ketone bodies in the prognosis of stroke has not been investigated well. This study aimed to investigate the association between urine ketone bodies and adverse outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods: This study enrolled 14 015 patients with AIS or TIA who screened for urine ketone bodies from the Third China National Stroke Registry. Status of urine ketone bodies were classified into negative, suspicious positive and positive. The outcomes were all-cause death and poor functional outcomes (modified Rankin Scale [mRS] 2–6/3-6) at 3 months and 1 year. Multivariable Cox proportional hazards regressions and logistic regressions were adopted to explore the associations. Results: Participants with negative, suspicious positive and positive urine ketone bodies were 12979 (92.61%), 480 (3.42%) and 556 (3.97%). After multivariate adjustment, patients with positive urine ketone bodies had a higher risk of all-cause death (hazard ratio, 1.74; confidence interval [CI], 1.07–2.83), a higher proportion of mRS score 2–6 (Odds ratio [OR], 1.85; 95% CI, 1.51–2.27), mRS score 3–6 (OR, 2.00; 95% CI, 1.61–2.48) at 3 months, compared to those with negative urine ketone bodies. Significant associations persisted at 1 year. Furthermore, there was no significant interaction of diabetes status and alcohol use with urine ketone bodies. Conclusions: Positive urine ketone bodies can independently predict all-cause death and poor functional outcomes in patients with AIS or TIA.