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

Low vitamin B12 levels may predict the risk of ischemic stroke: A cross-sectional study

BACKGROUND

To examine serum vitamin B12 concentrations in relation to the risk of ischemic stroke among hospitalized patients in the Department of Neurology.

METHODS

We performed a cross-sectional study involving 2,212 inpatients discharged from the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University, from January 2020 to January 2022. The results of laboratory assays such as serum vitamin B12, homocysteine, and folate levels were measured. Logistic regression analysis was used to investigate the association between serum vitamin B12 concentrations and ischemic stroke, with adjustment for a number of relevant demographic and lifestyle factors and comorbidities.

RESULTS

A total of 961 (43.4%) patients had an ischemic stroke. In the fully adjusted model, logistic regression analysis suggested a positive association between serum vitamin B12 levels<150 pg/mL (aOR: 1.42; 95% CI 1.02-1.97; p = 0.035), serum vitamin B12 150-300 pg/mL (aOR: 1.37; 95% CI 1.11-1.68; p = 0.003) and the prevalence of ischemic stroke. Furthermore, an inverse association was observed between serum vitamin B12 levels ≥ 900 pg/mL (aOR: 0.38; 95% CI: 0.19-0.77; p =0.007) and the prevalence of ischemic stroke. Moreover, the cut-off value of vitamin B12 concentration was 316.4 pg/mL and the discrimination power of the score evaluated by AUC-ROC was 0.71 (95%CI 0.68-0.73, p<0.001) in the vitamin B12 and ischemic stroke.

CONCLUSION

Findings suggest that low vitamin B12 levels may predict the risk of ischemic stroke, early and timely supplementation of vitamin B12 can improve the short-term prognosis of ischemic stroke patients.

Clinical Utility of Serum Holotranscobalamin Measurements in Patients with First-Ever Ischemic Stroke

Background

Whether holotranscobalamin (holoTC) indicates B12 deficiency more sensitively than total vitamin B12 (B12) is unclear. This study is aimed at determining the impact of serum holoTC level as a risk factor for ischemic stroke and investigating its association with disease severity and short-term outcomes.

Methods

Serum holoTC, total B12, and homocysteine levels were compared between 130 stroke patients and 138 healthy controls. Biomarker level correlations with disease severity and stroke functional outcomes were investigated.

Results

holoTC levels were lower and homocysteine levels were higher in stroke patients than in healthy controls (P < 0.05). The holoTC/total B12 ratio and homocysteine level significantly predicted ischemic stroke in the multivariable regression analysis (P < 0.05). Along with hyperhomocysteinemia, patients more often had holoTC than total B12 deficiency (6.2% vs. 3.1%). holoTC levels negatively correlated with homocysteine levels (partial R -0.165, P < 0.05) in stroke patients in multiple linear regression analyses, but not total B12 levels. The holoTC level and holoTC/total B12 ratio, but not homocysteine and total B12 levels, negatively correlated with the National Institute of Health Stroke Scale (partial R, -0.405 and -0.207, respectively, P < 0.01).

Conclusions

Measurements of serum holoTC levels combined with total B12 and homocysteine levels may provide valuable information for predicting ischemic stroke and its severity and short-term outcomes of ischemic stroke patients.

Estimation of stroke severity with National Institutes of Health Stroke Scale grading and retinal features: A cross-sectional study

To estimate National Institutes of Health Stroke Scale (NIHSS) grading of stroke patients with retinal characteristics.A cross-sectional study was conducted in Shenzhen Traditional Chinese Medicine Hospital. Baseline information and retinal photos were collected within 2 weeks of admission. An NIHSS score was measured for each patient by trained doctors. Patients were classified into 0 to 4 score group and 5 to 42 score group for analysis. Three multivariate logistic models, with traditional clinical characteristics alone, with retinal characteristics alone, and with both, were built.For clinical characteristics, hypertension duration is statistically significantly associated with higher NIHSS score (P = .014). Elevated total homocysteine levels had an OR of 0.456 (P = .029). For retinal characteristics, the fractal dimension of the arteriolar network had an OR of 0.245 (P < .001) for the left eyes, and an OR of 0.417 (P = .009) for right eyes. The bifurcation coefficient of the arteriole of the left eyes had an OR of 2.931 (95% CI 1.573-5.46, P = .001), the nipping of the right eyes had an OR of 0.092 (P = .003) showed statistical significance in the model.The area under receiver-operating characteristic curve increased from 0.673, based on the model with clinical characteristics alone, to 0.896 for the model with retinal characteristics alone and increased to 0.931 for the model with both clinical and retinal characteristics combined.Retinal characteristics provided more information than clinical characteristics in estimating NIHSS grading and can provide us with an objective method for stroke severity estimation.

Age-Dependent Association Between Elevated Homocysteine and Cognitive Impairment in a Post-stroke Population: A Prospective Study

Background and Purpose: The results regarding the independent association between homocysteine (Hcy) levels and post-stroke cognitive impairment (PSCI) were inconsistent. The effect of age on this association has yet to be explored. This study aims to determine the relationship between Hcy levels, age, and cognitive impairment in a post-stroke population.

Methods: A total of 592 patients with acute ischemic stroke (AIS) completed follow-up. Serum Hcy levels were measured enzymatically by spectrophotometry within 24 h of admission. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) 1 month after stroke, and the scores ≤ 24 were considered as cognitive impairment. Our study was dichotomized into two groups by a cut-off of 65 years. Multivariate logistic regression models were used to determine the association between baseline Hcy levels and cognitive impairment.

Results: According to the MMSE score, 317 (53.5%) patients had cognitive impairment. Patients with higher levels of Hcy were more prone to have cognitive impairment 1 month after stroke than patients with lower levels of Hcy (p < 0.001). The optimal cut-off points of Hcy level (μmol/L) were (T1) ≤ 8, (T2) 8–12, and (T3) ≥ 12. After adjusting for confounding factors, the multivariate regression analysis showed that the third Hcy tertile was independently associated with cognitive impairment [odds ratio (OR) = 2.057, 95% confidence interval (CI) = 1.133–3.735, p = 0.018). A stronger association [T2 (OR = 2.266, 95% CI = 1.042–4.926, p = 0.039); T3 (OR =3.583, 95% CI = 1.456–8.818, p = 0.005)] was found in the younger group. However, the independent association was not confirmed in the older group.

Conclusions: Elevated Hcy levels in the acute phase of ischemic stroke were independently associated with cognitive impairment in a post-stroke population. Furthermore, the association was age-dependent and more meaningful in a younger population aged below 65. So, Hcy levels in patients with stroke should be well-monitored, especially in younger patients.

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

Background: This comprehensive meta-analysis aimed to assess whether an increased homocysteine (Hcy) level is an independent predictor of unfavorable outcomes in acute ischemic stroke (AIS) patients.

Methods: A comprehensive literature search was conducted up to August 1, 2020 to collect studies reporting Hcy levels in AIS patients. We analyzed all the data using Review Manager 5.3 software.

Results: Seventeen studies with 15,636 AIS patients were selected for evaluation. A higher Hcy level was associated with a poorer survival outcome (OR 1.43, 95% CI: 1.25–1.63). Compared with the AIS group, Hcy levels were significantly lower in the healthy control patients, with an SMD of 5.11 and 95% CI (1.87–8.35). Analysis of the different subgroups of AIS demonstrated significant associations between high Hcy levels and survival outcomes only in Caucasian and Asian patients. Moreover, whereas high Hcy levels were closely associated with gender, B12 deficiency, smoking, and patients who received tissue plasminogen activator treatment, no significant difference was found between increased Hcy levels and age, drinking, hypertension, diabetes mellitus, and hyperlipidemia. In addition, the cut-off value (20.0 μmol/L) might be an optimum cut-off index for AIS patients in clinical practice.

Conclusion: This meta-analysis reveals that the Hcy level may serve as an independent predictor for unfavorable survival outcomes in AIS patients, particularly in Caucasian and Asian AIS patients. Further studies can be conducted to clarify this relationship.

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

BACKGROUND

Acute ischemic stroke (AIS) is mainly caused by cerebral blood flow disorders, which further leads to ischemic brain necrosis or encephalomalacia. The role of homocysteine (Hcy), an independent risk factor for cardiovascular disease, in the development of atherosclerosis is gradually revealed. However, studies are still rare and little is known about the relationship of Hcy level with the prognosis.

AIM

To explore the relationship between Hcy level and prognosis in elderly patients with AIS after thrombolytic therapy with recombinant tissue plasminogen activator (rtPA).

METHODS

A total of 120 patients with acute ischemic stroke who were admitted to Jingzhou Central Hospital and underwent recombinant tissue plasminogen activator treatment were randomly selected from January 2017 to December 2018. They were divided into two groups according to the level of Hcy, with 60 patients in each group. Patients with Hcy ≥ 18.54 umol/L were included into a high-level group and those with Hcy < 18.54 umol/L were included into a low-level group. The outcomes were analyzed in the two groups after the treatment.

RESULTS

The National institute of Health Stroke Scale (NIHSS) scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment (P < 0.05). There was no significant difference in NIHSS scores between the two groups at 12 and 24 h after the treatment (P > 0.05). The Modified Rankin scale (MRS) scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment (P < 0.05). There was no significant difference in MRS scores between the two groups at 12 and 24 h after the treatment (P > 0.05). NIHSS and MRS scores were positively correlated with the prognosis after thrombolytic therapy (P < 0.05).

CONCLUSION

The level of Hcy is closely related to the prognosis of elderly patients with acute ischemic stroke, and after rtPA treatment, the prognosis of elderly patients is improved significantly.

Changes of complement and oxidative stress parameters in patients with acute cerebral infarction or cerebral hemorrhage and the clinical significance

Changes of complement and oxidative stress parameters in patients with acute cerebral infarction (ACI) or cerebral hemorrhage (CH), and their clinical significance were explored. A total of 122 patients with ACI or CH admitted to the People's Hospital of Zhangqiu Area from August 2018 to September 2019 were collected. There were 59 ACI patients assigned into a cerebral infarction group (CIG) and further 63 CH patients in a cerebral hemorrhage group (CHG). Additionally, 53 healthy people in physical examination during the same period were enrolled as a control group (CG). Both the CIG and the CHG were treated with edaravone, Xueshuantong, brain protein hydrolysates, aspirin and statin-related drugs. The levels of complement C3, complement C4, superoxide dismutase (SOD), and total antioxidant capacity (TAC) were determined. Receiver operating characteristic (ROC) curves were employed to analyze the predictive value of C3, C4, SOD and TAG in ACI and CH, and logistic regression was used to analyze the risk factors of stroke. Both CIG and CHG showed higher C3 level, and lower C4, SOD and TAC levels than the CG. The NIHSS <4 group and the NIHSS ≥4 group showed higher hs-C3 level, and lower SOD and TAC levels than the CG (all P<0.05), and the NIHSS <4 group showed lower C3 level and lower SOD and TAC levels than the NIHSS ≥4 group (all P<0.05). Hypertension and hyperlipidemia were independent risk factors of stroke. The serum complement and oxidative stress parameters in patients with ACI or CH can be determined through routine examination, and the nerve function deficit could be assessed by determining the complement and oxidative stress parameters in clinical practice.

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

BACKGROUND

Although increasing evidence has demonstrated that elevated homocysteine (Hcy) levels may be an important contributor for the development of cerebral infarction, rare studies focused on its diagnostic and early prognostic roles in acute lacunar infarction.

METHODS

A total of 197 patients with acute lacunar infarction and 192 to form the control group were prospectively recruited between January 2013 and February 2017. Early neurological deterioration was defined as an increase of ≥2 points in National Institutes of Health Stroke Scale or the decrease in Barthel index (BI) score at discharge.

RESULTS

Univariate and multivariate logistic regression analyses revealed that higher levels of fibrinogen and Hcy were independently clinical predictors associated with lacunar infarction. Receiver operating characteristic curves analysis demonstrated that the diagnosis value of Hcy was superior to fibrinogen, with the area under the curve of 0.881 and 0.688 respectively. Using the optimal cutoff value of 15.5 μmol/L of Hcy, a sensitivity of 65% and a specificity of 100% were achieved for predicting lacunar infarction. Hcy was only significantly related with BI reduction in the males (30.5 [15.5-65.5] vs. 18 [15-24], p = 0.034) in the univariate analysis but not in the females and the multivariate analysis.

CONCLUSIONS

Serum Hcy may be an independent diagnostic and not an early prognostic biomarker for patients with acute lacunar infarction.