Elevated Total Homocysteine Predicts In-Hospital Pneumonia and Poor Functional Outcomes in Acute Ischemic Stroke

Abstract

Background : We investigated the association between elevated total homocysteine (tHcy) levels upon hospital admission and short-term in-hospital outcomes including pneumonia in acute ischemic stroke (AIS) patients. Methods: A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of admission tHcy: quartile (Q1) (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all-cause in-hospital mortality and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. Results: The risk of in-hospital pneumonia was significantly higher in patients with highest tHcy level (Q4) compared to those with lowest tHcy level (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P-trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality (OR 3.35; 95% CI, 1.11–10.13; P-trend =0.015) and poor outcome upon discharge (OR 1.50; 95% CI, 1.06–2.12; P-trend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. Conclusion: Having a high admission tHcy level was independently associated with in-hospital pneumonia, in-hospital mortality and poor outcome upon discharge in AIS patients.

Low estimated glomerular filtration rate explains the association between hyperhomocysteinemia and in-hospital mortality among patients with ischemic stroke/transient ischemic attack or intracerebral hemorrhage: Results from the Chinese Stroke Center Alliance

“…Our results overturn the contention of some previous researchers: Elevated homocysteine concentrations were found to be an independent prognostic marker of short-term mortality in patients with IS. 23,24 The results support the findings of Forti et al 25 and Wang et al, 26 which showed that high admission plasma tHcy was unrelated to in-hospital mortality. Such controversies were thought to be related to the lack of adjustment for the eGFR and the small sample size.…”

Homocysteine and Clinical Outcomes in Intracerebral Hemorrhage Patients: Results from the China Stroke Center Alliance

“…However, one study indicated that acute ischemic stroke patients with elevated total Hcy levels had a 1.55-fold increased risk of in-hospital pneumonia. 26 Hcy is currently considered to be a useful marker for inflammation. Considering the inflammation and oxidative stress theory of atherosclerosis, HHcy might accelerate the generation of high-sensitivity C-reactive protein, interleukin-8, caspase-9, matrix metalloproteinase, and other proteins that participate in the early-state formation of atherosclerosis 27 and the accumulation of inflammatory factors also might result in pneumonia.…”