The Relationship Between Homocysteine And Short-term Prognosis In Patients With Acute Ischemic Stroke

Background and Objective:A number of epidemiological studies have indicated that hyperhomocysteinemia(HHcy)is a risk factor for ischemic stroke.Meanwhile,the results from clinical studies have showed that baseline homocysteine(Hey)was associated with long-term prognosis in patients with acute ischemic stroke(AIS).However,evidence on the association between serum Hey levels at admission and early outcomes in AIS patients are limited and conflicting,our study was aimed to investigate the relationship between Hey and short-term outcome in patients with AIS.Methods:A retrospective cohort study was conducted in Suzhou region in 3450 hospitalized patients with AIS,which was collected from 22 hospitals from December 2013 to May 2014.1366 patients were excluded due to lack of Hey data,and 2084 patients were included in the study.Patients were divided into 4 groups according to the quartiles distribution of baseline Hey levels:<9.70umol/L,9.70-12.3 umol/L,12.3-16.9 umol/L,and?16.9 umol/L.Poor short-term outcomes were defined as death during hospitalization,death or disability at discharge(modified Rankin scoring scale(mRS)?3).Univariate and multivariate Logistic regression were used to analyze the relationship between baseline Hcy and short-term outcome.Results:1)Of the 2084 patients,57(2.7%)patients died during hospitalization and 784(37.6%)patients experienced poor outcome at discharge.2)In the unadjusted Logistic regression model,in-hospital mortality was significantly higher among study participants with baseline Hey in the highest quartile(Q4)compared with those in the lowest quartile(Ql)(OR 4.46,95%Cl:1.82-10.92;P-txend<0.O01).After adjusting for factors such as age,gender,history of hypertension and baseline NIHSS score,and other covariates,the OR(95%Cl)for the highest quartile(Q4)of Hey at baseline was 3.63(95%Cl 1.24-10.65;P-trend=0.009)for mortality,as compared with the lowest quartile(Ql).3)In the unadjusted Logistic regression model,poor outcome at discharge was significantly higher among study participants with baseline Hey in the highest quartile(Q4)compared with those in the lowest quartile(Q1)(OR 1.61,95%Cl 1.25-2.08;P-trend<0.001).After adjusting for factors such as age,gender,history of hypertension and baseline NIHSS score,and other covariates,the OR(95%CI)for the highest quartile(Q4)of Hcy at baseline was 1.58(95%Cl 1.12-2.23;P-trend=0.018)for poor outcome at discharge,as compared with the lowest quartile(Q1).4)Significant associations between admission Hcy levels and in-hospital mortality or poor outcome at discharge were observed in all subgroups(age,gender,systolic blood pressure,diabetes mellitus,and different onset times).However,no significant interaction between admission Hey and subgroup variables was observed(P-interaction>0.05 for all).Conclusion:In patients with acute ischemic stroke,there is a significant association between baseline Hey level and short-term outcomes.An increased Hey level at admission is a significant prognostic factor associated with in-hospital mortality and poor discharge outcome in acute ischemic stroke patients.Baseline homocysteine level may be an effective predictor of short-term outcomes in patients with acute ischemic stroke.