title: Acute phase homocysteine related to severity and outcome of atherothrombotic stroke.
abstract: BACKGROUND
  Homocysteine (HCY) is associated with risk of stroke, but whether HCY affects stroke severity and prognosis remains controversial. We hypothesized HCY has an impact on atherothrombosis and this prospective study was aimed to explore the association between acute phase HCY with stroke severity and outcome in patients with atherothrombosis.
  
  
  METHODS
  Patients <72 h after symptom onset were categorized by the modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and those typed as atherothrombosis were included. Neurologic function was assessed with National Institute of Health Stroke Score (NIHSS) <72 h after symptom onset and Modified Rankin Scale (mRS) and Barthel Index (BI) 6-month, 12-month and 18-month poststroke respectively. HCY was recorded <72 h after symptom onset. Participants were divided into hHCY (HCY>15 μmol/l) and nhHCY (HCY≤15 μmol/l). The correlation between HCY and mRS was analyzed.
  
  
  RESULTS
  125 of 130 participants without HCY interventional therapy completed the 18-month follow-up. There was no difference in demographics, histories of hypertension, diabetes mellitus, coronary heart disease, previous cerebral vascular event, and plasma low-density lipoprotein between hHCY and nhHCY. NIHSS, mRS were significantly higher and BI was significantly lower in hHCY than in nhHCY. The 18-month recurrence rate in hHCY (21.0%) was significantly higher than that in nhHCY (6.8%). Spearman correlation analysis revealed correlation between HCY and mRS (p=0.000). By ordinal logistic regression, HCY was an independent predictor of 18-month mRS (odds ratio 1.08, 95% confidence interval 1.04-1.13, p=0.000).
  
  
  CONCLUSIONS
  Acute phase elevated HCY correlated with severity and prognosis in patients with atherothrombotic stroke.
authors: Department of Neurology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.
authors: Xu-Qing
authors: XQ
authors: Wu
authors: Jing
authors: J
authors: Ding
authors: An-Yan
authors: AY
authors: Ge
authors: Fei-Feng
authors: FF
authors: Liu
authors: Xin
authors: X
authors: Wang
authors: Wei
authors: W
authors: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D013927:Thrombosis / Q000150:complications*
chemical_list: D006710:Homocysteine