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

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>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.</jats:p> </jats:sec>

The Prognostic Value of Homocysteine in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

“…(4) Hcy may serve as an independent risk factor influencing the survival outcome of AIS patients, particularly in Caucasians and Asians. Furthermore, our findings highlight that the Hcy level is a prognostic factor for AIS and suggest that thrombolytic therapy may be helpful in the high-risk subgroup of patients (Yao et al, 2016;Li L. et al, 2020).…”

“…The initial search identified 236 articles. Eventually, 17 articles published from 2001 to 2020 were included (Fallon et al, 2001;Sacco et al, 2004;Mizrahi et al, 2005;Perini et al, 2005;Yoldas et al, 2007;Okubadejo et al, 2008;Tu et al, 2013;Unal et al, 2013;Kwon et al, 2014;Shi et al, 2015;Forti et al, 2016;Tang et al, 2016;Yao et al, 2016;Markaki et al, 2017;Zhong et al, 2017;Alfieri et al, 2020;Li L. et al, 2020) (Figure 1). All studies reported follow-up time.…”

Efficacy, Influencing Factors, and Safety of Alteplase Intravenous Thrombolysis in Patients with Acute Ischemic Stroke Combined with Atrial Fibrillation

“…e NHISS score is a scale for evaluating the neurological functional recovery status of patients with stroke. A high NHISS score indicates how serious the nerve damage is, indicating that the recanalization rate after thrombolysis is low for patients [22]. erefore, close observation of NHISS score changes in ICS patients with atrial fibrillation and early intervention in patients with high risk factors can help doctors effectively judge the severity of patients' disease and the outcome of curative effects and improve the effectiveness of clinical treatment.…”

Impact of glutathione on acute ischemic stroke severity and outcome: possible role of aminothiols redox status

“…Conversely, some publications showed no significant prognostic effect of tHcy on neurological deficits. For example, it was concluded that the clinical contribution of tHcy to the functional IS outcome in the first 3 months was negligible, despite the reliable association of these indicators [ 13 ]. In spite of the correlation of tHcy with the neurological deficit at admission, no association with the functional outcome was found after 3 and 6 months after IS [ 7 ].…”