Dataset Information

Higher serum homocysteine levels are associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.

ABSTRACT:

Background

Hemorrhagic transformation (HT) is a common complication of acute ischemic stroke (AIS), and may develop into parenchyma hemorrhage (PH). We aimed to investigate the association between serum homocysteine levels and HT as well as PH in all AIS patients, and in those with and without thrombolysis by subgroup analysis.

Methods

AIS patients who were admitted within 24 h after onset were enrolled and categorized into the higher homocysteine level group (≥ 15.5 µmol/L) and the lower homocysteine level group (< 15.5 µmol/L). HT was determined by a second round of brain imaging within 7 days during hospitalization, and PH was defined as hematoma in the ischemic parenchyma. Multivariate logistic regression was used to investigate the associations between serum homocysteine levels and HT and PH, respectively.

Results

Of the 427 included patients (mean age 67.35 years, 60.0% males), 56 (13.11%) developed HT and 28 (6.56%) had PH. Serum homocysteine levels were significantly associated with HT (adjusted OR 1.029, 95%CI 1.003-1.055) and PH (adjusted OR 1.041, 95%CI 1.013-1.070). The higher homocysteine group was more likely to have HT (adjusted OR 1.902, 95% CI 1.022-3.539) and PH (adjusted OR 3.073, 95% CI 1.327-7.120) than the lower homocysteine group. Subgroup analysis of patients without thrombolysis also showed the significant differences in HT (adjusted OR 2.064, 95% CI 1.043-4.082) and PH (adjusted OR 2.926, 95% CI 1.196-7.156) between the two groups.

Conclusion

Higher serum homocysteine levels are associated with an increased risk of HT and PH in AIS patients, especially in those without thrombolysis. Monitoring the serum homocysteine may be conducive to determining individuals at a high risk of HT.

SUBMITTER: Wu Q

PROVIDER: S-EPMC10007840 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Higher serum homocysteine levels are associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.

Wu Qian Q Liu Junfeng J Wang Yanan Y Cheng Yajun Y Liu Ming M

BMC neurology 20230311 1

<h4>Background</h4>Hemorrhagic transformation (HT) is a common complication of acute ischemic stroke (AIS), and may develop into parenchyma hemorrhage (PH). We aimed to investigate the association between serum homocysteine levels and HT as well as PH in all AIS patients, and in those with and without thrombolysis by subgroup analysis.<h4>Methods</h4>AIS patients who were admitted within 24 h after onset were enrolled and categorized into the higher homocysteine level group (≥ 15.5 µmol/L) and t ...[more]

PMID: 36906541

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Project description:BackgroundEnlarged perivascular spaces (EPVS) are considered to be neuroimaging markers of cerebral small vessel disease (CSVD). It remains unknown whether EPVS are associated with hemorrhagic transformation (HT) after acute ischemic stroke (AIS). We performed this retrospective cohort study to explore the associations of EPVS with clinical risk factors and other CSVD imaging features, and to investigate the relationship between EPVS and HT in patients with AIS.MethodsAIS patients admitted within 24 hours of stroke onset between January 2016 and December 2017 were consecutively enrolled. EPVS, lacunes, and white matter hyperintensities (WMH) were rated with validated rating scales on magnetic resonance images after the stroke. HT was defined as hemorrhage determined by follow-up brain imaging during the patients' hospital stay. Logistic regression was used to determine the risk factors and associations with other CSVD markers of EPVS in the basal ganglia (BG) and centrum semiovale (CS) regions, and the impact of EPVS on HT was further explored.ResultsAmong 494 included patients (mean age 66.4 years, 58.1% male), 81 (16.4%) experienced HT. In the multivariate logistic analyses, increasing age [odd ratio (OR) 1.041, 95% confidence interval (CI), 1.017-1.066], hypertension (OR 2.174, 95% CI, 1.338-3.532), lacunar stroke (OR 1.968, 95% CI, 1.169-3.314), CS-EPVS (OR 2.474, 95% CI, 1.796-3.407), and periventricular WMH (OR 2.140, 95% CI, 1.441-3.176) were significantly associated with BG-EPVS; whereas only BG-EPVS (OR 4.349, 95% CI, 2.281-8.291) were independently related to CS-EPVS. After adjustment for potential variables, neither BG-EPVS (OR 0.674, 95% CI, 0.336-1.350) nor CS-EPVS (OR 0.792, 95% CI, 0.334-1.879) was significantly associated with the occurrence of HT.ConclusionsOur data showed that EPVS in the BG and CS regions were interrelated and had different risk factors in ischemic stroke patients. EPVS (particularly that in BG) were independently related to other CSVD markers. The presence or burden of EPVS was not significantly associated with HT after AIS.

Project description:IntroductionIt is well known that post-stroke depression (PSD) is a psychiatric complication after stroke which leads to worse functional outcome and poorer quality of life. Some risk factors including gender, stroke severity, lesion location, homocysteine (HCY), and so on are associated with PSD. This study aims to further explore the possible relationship between serum levels of HCY and early-onset PSD and the predictive value of HCY combined with stroke characteristics for early-onset PSD.MethodsTwo hundred forty-five patients with acute ischemic stroke who met the criteria were included in this study from March 2015 to March 2017. PSD was diagnosed at 2 weeks after stroke. The severity of depressive symptoms was evaluated with the Hamilton depression scale 17 items (HAMD-17), and patients with HAMD scores ≥7 were included in the PSD group. The demographic data, clinical characteristics, serum levels of HCY, and detailed radiological variables (e.g., lesion location and quantity of the brain infarct) were also examined.ResultsIn total, 97 (39.6%) patients of the 245 patients were diagnosed with depression. The univariate analyses suggested that patients in PSD group had a higher NIHSS score, modified Rankin Scale score, and HCY levels than patients in non-PSD group (p < .001). The patients with PSD had higher proportion of multiple-site acute infarcts and frontal lobe lesion (p < .05). In multivariate logistic regression analysis, NIHSS score at admission, serum levels of HCY, and multiple-site lesions were independently related to early-onset PSD. Based on receiver operating characteristic curves analysis, the combination of HCY, NIHSS scores, multiple-site lesions, and lesion location revealed a highest area under the curve of 0.807 (95% confidence interval [CI]: 0.748-0.865, p < .001). Furthermore, there was a significantly increased risk of early-onset PSD associated with serum levels of HCY ≥16.98 μmol/L (odds ratio [OR] = 10.976, 95% CI: 5.585-21.573, p < .001).ConclusionsOur study indicated that higher NIHSS score, elevated serum levels of HCY, and multiple-site lesions may be independent risk factors of early-onset PSD. The combination of HCY, NIHSS scores, multiple-site lesions, and lesion location may provide greater predictive value than HCY alone for early-onset PSD. Early intervention for elevated serum levels of HCY may be a potential target for the intervention and prevention of PSD.

Dataset Information

Higher serum homocysteine levels are associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.

Background

Methods

Results

Conclusion

Publications

Higher serum homocysteine levels are associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.

Similar Datasets

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