No Association between Elevated Total Homocysteine Levels and Functional Outcome in Elderly Patients with Acute Cerebral Infarction

Abstract

Background: An elevated plasma total homocysteine (tHcy) level is an independent risk factor for vascular events. The aim of the present study was to investigate the association between tHcy levels in the acute phase of cerebral infarction and functional outcome among elderly patients.Methods: Between October 2009 and December 2012, we recruited 594 elderly patients (age > 75) with first-onset acute cerebral infarction who were consecutively admitted to the Department of Neurology of Tianjin Huanhu Hospital, China. Levels of tHcy and other biochemical values were measured within 24 h after admission. tHcy values were classified according to quartiles (<9.94; 9.94 to <12.7; 12.7 to <16.8; and ≥16.8 μmol/L). We examined the relationship between tHcy levels at admission and modified Rankin Scale scores (mRS) using univariate and multivariate analyses. Patients were followed up at 3 months and 1 year after stroke.Results: Within 3 months after stroke, 64 patients died, 37 had recurrent ischemic stroke, and 22 were lost to follow-up; thus, 471 patients were reviewed and analyzed. By the time of the 1-year follow-up, an additional 48 patients had died, 44 had recurrent ischemic stroke, and 40 had been lost to follow-up; the remaining 339 patients were thus reviewed and analyzed. Elevated tHcy levels were not associated with functional outcome among elderly patients with acute cerebral infarction (p > 0.05). Only the National Institutes of Health Stroke Scale score was associated with a poor outcome after adjusting for confounders at 3 months and 1 year (adjusted odds ratio, 1.38; 95% CI, 1.28–1.49; p < 0.01; adjusted odds ratio, 1.34; 95% CI, 1.25–1.44; p < 0.01, respectively).Conclusion: Among elderly patients with acute cerebral infarction, elevated tHcy at admission was not a predictive factor of outcome at 3 months and 1 year after stroke onset.

Assessment of Homocysteine as a Diagnostic and Early Prognostic Biomarker for Patients with Acute Lacunar Infarction

“…This hypothesis has been observed in several clinical studies, with the high levels of serum Hcy as independent predictors for END for stroke patients [11, 14]. However, a recent study suggested conflicting results, demonstrating no association between elevated Hcy levels and functional outcome among elderly patients with acute cerebral infarction [15]. Therefore, the second goal of this study was to investigate the early prognostic roles of Hcy for patients with lacunar infarction.…”

“…These findings suggest that Hcy may be an effective biomarker for early diagnosis and prognosis of lacunar infarction. However, a recent study suggested conflicting results, demonstrating no association between elevated Hcy levels and functional outcome among elderly patients with acute cerebral infarction [15]. Importantly, no significant difference in the Hcy level was found among the Iranian population between lacunar causes and control [12].…”

Relationship between homocysteine level and prognosis of elderly patients with acute ischemic stroke treated by thrombolysis with recombinant tissue plasminogen activator

“…Moreover, increased free radicals from hydrogen peroxide (H 2 O 2 ) will exacerbate endothelial dysfunction[12]. Hcy level is an important factor in predicting the prognosis of thrombolysis, which is associated with limited report on the assessment of risks in elderly patients receiving thrombolysis[13]. The results of the present study revealed that NIHSS scores were improved and high Hcy level gradually went back to normal, which was not significantly different from low Hcy level ( P > 0.05).…”

Níveis plasmáticos de homocisteína em mulheres idosas com úlceras nos pés

“…Corroborando com nossos dados, González et al 4 , avaliou pacientes com idade igual ou superior a 40 anos e os resultados apresentaram níveis elevados de homocisteína no grupo úlcera quando comparado ao grupo controle. A hiperhomocisteinemia associa-se com a formação de tromboembolismo arterial e venoso e aterosclerose 19,20 . A homocisteína pode estimular a oxidação da lipoproteína de baixa densidade (LDL), sendo esta condição associada a lesões endoteliais, trombogênese e aterogênese 2,8 .…”

“…A hiperhomocisteínemia é estabelecida como um fator de risco para doenças cardiovasculares 9,20 , demonstrando associação com as doenças vasculares periféricas, o que suporta a hipótese de que níveis elevados de homocisteína podem ser um marcador/indicador de alterações vasculares 6,21 .…”