Effect of Hyperhomocysteinemia on Clinical Outcome and Hemorrhagic Transformation After Thrombolysis in Ischemic Stroke Patients

Luo, Yun; Jin, Hang; Guo, Zhen‐Ni; Zhang, Peng; Zhang, Liyue; Chen, Jie; Yu, Yanbing; Wang, Yan; Liu, Jie; He, Qianyan; Sun, Xin; Yang, Yi

doi:10.3389/fneur.2019.00592

Cited by 16 publications

(11 citation statements)

References 36 publications

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“…To further confirm the association between Hcy levels and clinical outcome of AIS patients treated with thrombolytic therapy, we conducted this retrospective study. Consistent with the previous retrospective studies conducted by Ling et al (2018) , Luo et al (2019) and Yao et al (2016) , we found that there exists a correlation between Hcy levels and poor prognosis after acute thrombolytic therapy in AIS patients in this retrospective study. And we indicated that higher Hcy levels have a negative impact on prognosis.…”

Section: Discussionsupporting

confidence: 93%

“…Though a small number of studies have already been published, the prognostic value of Hcy levels in patients with AIS after IVT remains controversial. Some investigations revealed that Hhcy was correlated with unfavorable outcomes in patients with ischemic stroke ( Ling et al, 2018 ; Luo et al, 2019 ; Yao et al, 2016 ), whereas some other studies indicated that there was no significant correlation between Hhcy and ischemic stroke patients’ clinical outcome ( Ribo et al, 2004a , 2004b ). To further confirm the association between Hcy levels and clinical outcome of AIS patients treated with thrombolytic therapy, we conducted this retrospective study.…”

Section: Discussionmentioning

confidence: 99%

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Impact of homocysteine levels on clinical outcome in patients with acute ischemic stroke receiving intravenous thrombolysis therapy

Zeng

et al. 2020

PeerJ

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Background The purpose of this study was to retrospectively assess the potential correlation between clinical outcomes and homocysteine (Hcy) levels in acute ischemic stroke (AIS) patients after recombinant tissue plasminogen activator (rtPA) treatment. Methods AIS patients treated by rtPA were enrolled between September 2018 and March 2019 in the Stroke Center (Department of Neurology and Neurosurgery), Shanghai Tenth People’s Hospital, Tongji University School of Medicine. Demographics, baseline and clinical characteristics, and modified Rankin Scale (mRS) score after three months from the onset were retrospectively analyzed. Then we compared data about demographics, baseline and clinical characteristics between patients with favorable (mRS score 0–2) and unfavorable (mRS score 3–6) outcomes. Results Among 141 patients, 36 patients had poor outcome, for an incidence of 25.53%. Univariate analysis showed that higher Hcy levels (OR = 1.07, 95% CI [1.02–1.12]), older age (OR = 1.06, 95% CI [1.02–1.10]), longer door to needle time (DNT) (OR = 1.03, 95% CI [1.01–1.05]), higher D-Dimer levels (OR = 1.33, 95% CI [1.03–1.71]), and higher National Institutes of Health Stroke Scale (NIHSS) score before treatment (OR = 1.21, 95% CI [1.08–1.35]) were each associated with poor outcome. Also, without internal carotid artery plaque (OR = 0.30, 95% CI [0.10–0.92]) showed a protective effect on patients’ clinical outcome. Patients with higher levels of Hcy decline also showed an increased risk of poor outcome for AIS patients obtaining rtPA treatment (Non-adjusted: OR = 1.07, 95% CI [1.02–1.12]; Adjust model I adjusts for demographics (age, male): OR = 1.06, 95% CI [1.02–1.11]; Adjust model II adjusts for hospital care factors (onset to treatment, DNT): OR = 1.08, 95% CI [1.03–1.13]; Adjust model III adjusts for health and stroke factors (INR, D-Dimer, HGB, NIHSS score before treatment, smoking, drinking, hypertension, diabetes, coronary disease, hyperlipidemia, previous stroke, atrial fibrillation, hemorrhagic transformation, internal carotid artery plaque): OR = 1.06, 95% CI [1.02–1.11]). The results are very stable in all three models constructed. Conclusion The results of this study indicate that increased Hcy level independently predicts unfavorable outcome in AIS patients accepting thrombolytic therapy. However, the contribution of Hcy to the outcome, although significant, is relatively small and perhaps not clinically significant when all the other confounders are considered.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Impact of homocysteine levels on clinical outcome in patients with acute ischemic stroke receiving intravenous thrombolysis therapy

Zeng

et al. 2020

PeerJ

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“…Diabetes was defined as FBG levels ≥ 7.0 mmol/L or any self-declared history of diabetes or current drug use for diabetes [ 20 ]. Dyslipidemia was defined as those taking oral anti-dyslipidemic drugs, having any self-declared history, or at any one of the following outcomes: TG levels ≥ 1.70 mmol/L, TC levels ≥ 5.18 mmol/L, LDL-C levels ≥ 3.37 mmol/L, or HDL-C level ≤ 1.04 mmol/L [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Association between the triglyceride-glucose index and carotid plaque incidence: a longitudinal study

Zhang

et al. 2022

Cardiovasc Diabetol

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Background Carotid plaque and triglyceride-glucose (TyG) index are associated with insulin resistance. However, a highly debated question is whether there is an association between the TyG index and carotid plaque incidence. Thus we performed an in-depth longitudinal study to investigate the relationship between carotid plaque occurrence and the TyG index among Chinese individuals. Methods Two thousand and three hundred seventy subjects (1381 males and 989 females) were enrolled and followed up for three years. The subjects were stratified into four groups based on the quartile of the TyG index at baseline. Univariate and multivariate Cox proportional hazard models were conducted to examine the role of TyG played in the carotid plaque. The strength of association was expressed as hazard ratio (HR) and 95% confidence interval (CI). Results After three years of follow-up, 444 subjects were detected with newly formed carotid plaque. The overall 3-year cumulative carotid plaque incidence was 18.7%, and the risk of carotid plaque increased with elevated TyG index (p < 0.001). The Cox regression analysis showed that males (HR: 1.33, 95% CI: 1.10–1.61), and people with higher systolic blood pressure (HR:1.01, 95% CI: 1.01–1.02), lower high-density lipoprotein cholesterol (HR: 0.68, 95% CI: 0.50–0.93), diabetes (HR: 2.21, 95% CI: 1.64–2.97), and hypertension (HR:1.49, 95% CI: 1.23–1.81) had a significantly increased risk for the carotid plaque formation. Similar results remained in the sensitivity analysis. Conclusions The TyG index can be used as a dose-responsive indicator of carotid plaque in the Chinese population. Elderly males with dyslipidemia, diabetes, or hypertension should be more vigilant about their TyG index since they are susceptible to developing carotid plaque. Physicians are encouraged to monitor the TyG index to help identify and treat patients with carotid plaque at an early stage.

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“…45 A higher level of homocysteine was reported to be associated with an increased risk of poor outcome after thrombolysis in AIS patients. [46][47][48] Although found to be independent predictors after multivariable logistic analysis, hypertension and Hhcy are only a small proportion of our model. The AUC value of the N2H3 nomogram was 0.872 (95% CI, 0.841-0.902), which is higher than the value of the START nomogram (AUC, 0.766; 95% CI, 0.707-0.826).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early prediction of the 3-month outcome for individual acute ischemic stroke patients who received intravenous thrombolysis using the N2H3 nomogram model

Song

Zhang

et al. 2020

Ther Adv Neurol Disord

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Background: The aim of this study was to establish a nomogram model for individualized early prediction of the 3-month prognosis in patients with acute ischemic stroke (AIS) who were treated with intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis. Methods: A total of 691 patients were included in this study; 564 patients were included in the training cohort, while 127 patients were included in the test cohort. The main outcome measure was a 3-month unfavorable outcome (modified Rankin Scale 3–6). To construct the nomogram model, stepwise logistic regression analysis was applied to select the significant predictors of the outcome. The discriminative performance of the model was assessed by calculating the area under the receiver operating characteristic curve (AUC-ROC). A decision curve analysis was used to evaluate prognostic value of the model. Results: The initial National Institutes of Health Stroke Scale [NIHSS, odds ratio (OR), 1.35; 95% confidence interval (CI), 1.28–1.44; p < 0.001], delta NIHSS (changes in the NIHSS score from baseline to 24 h, OR, 0.75; 95% CI, 0.70–0.79; p < 0.001), hypertension (OR, 2.07; 95% CI, 1.32–3.31; p = 0.002), hyperhomocysteinemia (Hhcy, OR, 2.18; 95% CI, 1.20–4.11; p = 0.013), and the ratio of high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) (HDL-C/LDL-C, OR, 3.29; 95% CI, 1.00–10.89; p = 0.049) (N2H3) were found to be independent predictors of a 3-month unfavorable outcome from multivariate logistic regression analysis and were incorporated in the N2H3 nomogram model. The AUC-ROC of the training cohort was 0.872 (95% CI, 0.841–0.902), and the AUC-ROC of the test cohort was 0.900 (95% CI, 0.848–0.953). Conclusion: The study presented the N2H3 nomogram model, with initial NIHSS score, delta NIHSS, hypertension, Hhcy, and HDL-C/LDL-C as predictors. It therefore provides an individualized early prediction of the 3-month unfavorable outcome in AIS patients treated with intravenous rt-PA thrombolysis.

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Effect of Hyperhomocysteinemia on Clinical Outcome and Hemorrhagic Transformation After Thrombolysis in Ischemic Stroke Patients

Cited by 16 publications

References 36 publications

Impact of homocysteine levels on clinical outcome in patients with acute ischemic stroke receiving intravenous thrombolysis therapy

Impact of homocysteine levels on clinical outcome in patients with acute ischemic stroke receiving intravenous thrombolysis therapy

Association between the triglyceride-glucose index and carotid plaque incidence: a longitudinal study

Early prediction of the 3-month outcome for individual acute ischemic stroke patients who received intravenous thrombolysis using the N2H3 nomogram model

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