Dandan Wang, Zhentang Cao, Zixiao Li, Hongqiu Gu, Qi Zhou, Xingquan Zhao, Yongjun Wang
Objective: Elevated homocysteine (Hcy) levels play a detrimental role in ischemic Stroke. Acute spontaneous intracerebral hemorrhage (ICH) accounts for nearly 25% of all Stroke cases. However, the influence of Hcy levels and ICH severity on clinical outcomes is unclear.
Participants and Study Location: Data were obtained from 85,705 ICH patients enrolled in the China Stroke Center Alliance (CSCA) study, a national, hospital-based, multicenter, voluntary, quality assessment and improvement initiative performed in China. patients were divided into high and normal Hcy groups according to their Hcy levels observed at admission.
Outcome Measures: The outcome indices included severe ICH, in-hospital mortality, and a poor functional outcome at discharge. Multivariable logistic regression was used to analyze the association of different Hcy levels with outcomes.
Results: The final analysis included 55,793 ICH patients. High homocysteine (HHcy) levels had higher adjusted odds ratios for severe ICH (OR 1.09, 95% CI 1.01-1.10, <0.0001) and a poor functional outcome at discharge (OR 1.06, 95% CI 1.01-1.10, =0.0100) compared with normal Hcy levels. There was no significant difference between HHcy and in-hospital mortality. In the subgroup analysis, stratified by sex and history of hypertension, significant interactions were observed between HHcy and severe ICH ( for interactions was 0.0138 and 0.0120, respectively). HHcy levels exhibited greater associations for severe ICH in female patients (OR 1.07, 95% CI 1.02-1.12) and patients without hypertension (OR 1.20, 95% CI 1.09-1.33).
Conclusion: An elevated Hcy level exhibited significant association with severe ICH on admission and a poor functional outcome at discharge. The relationship between HHcy and ICH severity on admission was more robust in female patients and patients without hypertension. Hcy might be a valuable biomarker for ICH patients to predict severity at onset and functional outcome at discharge.
