Abstract
BACKGROUND: Post-stroke depression (PSD) affects 30% of acute ischemic stroke (AIS) survivors, compromising functional recovery and increasing mortality. Uric acid (UA) and high-density lipoprotein cholesterol (HDL) modulate oxidative stress and neuroinflammation, but their individual prognostic value is inconsistent. This study investigated whether the admission UA/HDL ratio (UHR) independently predicts 90-day PSD in AIS patients. METHODS: We retrospectively analyzed 541 AIS patients admitted to Shanxi Bethune Hospital (October 2023-December 2024). Inclusion required first-ever AIS confirmed by CT or MRI within 72 hours. Demographics, clinical variables, and laboratory data were collected. Multivariable logistic regression, subgroup analyses, and restricted cubic spline models evaluated associations between UHR and PSD, adjusting for confounders. RESULTS: Of 541 patients, 193 (35.7%) developed PSD. PSD patients had higher UHR, elevated NIHSS scores, reduced neutrophil counts, and lower cognitive scores (all p<0.05). UHR independently predicted PSD (adjusted OR per 1-unit increase: 1.0023 and per 1-SD increase: 1.4725; p=0.0042). Patients in the highest UHR quartile had a 2.17-fold higher PSD risk versus the lowest quartile (p=0.044), with a significant linear dose-response (p=0.013). Subgroup analyses confirmed consistent associations across stroke severity, sex, and comorbidities. CONCLUSIONS: Admission UA/HDL ratio is a robust, independent predictor of 90-day PSD in AIS patients. As an accessible, cost-effective marker, UHR may enable early identification of high-risk individuals during the acute post-stroke phase.