Open AccessHomocysteinemia and early outcome of acute ischemic stroke in elderly patients
Author(s) -
Forti Paola,
Maioli Fabiola,
Ar Giorgia,
Coveri Maura,
Pirazzoli Gian Luca,
Zoli Marco,
Procaccianti Gaetano
Publication year - 2016
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.460
Subject(s) - medicine , interquartile range , modified rankin scale , odds ratio , confidence interval , univariate analysis , logistic regression , stroke (engine) , hyperhomocysteinemia , incidence (geometry) , homocysteine , ischemic stroke , multivariate analysis , ischemia , mechanical engineering , physics , optics , engineering
Objectives Plasma total homocysteine ( tH cy) is a risk factor for ischemic stroke ( IS ) but its relationship with IS outcome is uncertain. Moreover, previous studies underrepresented older IS patients, although risk of both hyperhomocysteinemia and IS increases with age. We investigated whether, in elderly patients with acute IS , tH cy measured on admission to the Stroke Unit ( SU ) is an independent predictor of SU discharge outcomes. Materials and Methods Data are for 644 consecutive patients aged 80.3 ± 8.7 years, admitted to an Italian SU with diagnosis of acute IS . Plasma tH cy was measured on SU admission. Investigated outcomes included mortality during SU stay and poor functional status (modified Rankin Scale score ≥3) at SU discharge for survivors. The association of plasma tH cy with the study outcomes was assessed using Odds Ratios ( OR ) and their corresponding 95% confidence intervals (95% CI ) from logistic regression models adjusted for demographics, pre‐stroke features, IS severity, and laboratory data on SU admission (serum C‐reactive protein, serum albumin, and renal function). Results Median plasma tH cy was 16.7 μ mol/L (interquartile range, 13.0–23.3 μ mol/L). Outcome incidence was 5.3% for mortality and 49.7% for poor functional status. Plasma tH cy was unrelated to mortality in both univariate and multivariable‐adjusted analyses. Conversely, plasma tH cy was associated with poor functional status of survivors in univariate analyses ( P = 0.014). Multivariable‐adjusted analyses showed that, compared to normal homocysteinemia ( tH cy <16 μ mol/L), risk of being discharged with poor functional status significantly increased for moderate ( tH cy ≥30 mol/L) but not mild (16.0–29.9 μ mol/L) hyperhomocysteinemia. Conclusions In elderly patients with acute IS , high admission plasma tH cy is unrelated to mortality during SU stay but is an independent predictor of poor functional status at SU discharge in survivors. The association, however, is limited to patients with moderate hyperhomocysteinemia.