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

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Oh Joo Kweon ◽  
Yong Kwan Lim ◽  
Mi-Kyung Lee ◽  
Hye Ryoun Kim
Keyword(s):  
Ischemic Stroke ◽  
Disease Severity ◽  
Functional Outcomes ◽  
Homocysteine Level ◽  
Healthy Controls ◽  
Stroke Patients ◽  
Short Term ◽  
B12 Deficiency ◽  
Multivariable Regression ◽  
The Impact

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.

scholarly journals Does hemorrhagic transformation in patients with ischemic stroke predict worse functional outcomes?

2021 ◽  
Author(s):  
vã Taiuan Fialho Silva ◽  
Vinícius Bessa Mendez ◽  
Fernanda Ferreira de Abreu ◽  
Alice Monteiro Soares Cajaíba ◽  
Pedro Antonio Pereira de Jesus
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Stroke Unit ◽  
Functional Disability ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Short Term ◽  
Relevant Variables ◽  
Patient Prognosis ◽  
The Impact

Background: Hemorrhagic transformation (HT) is a complication of stroke described as cause of early neurologic deterioration. Previous studies are discordant about the real impact of HT on stroke prognosis. Objectives: to describe the impact of HT in patient prognosis. Design and setting: Prospective cohort with acute ischemic stroke patients from a Stroke Unit, admitted between 2017 to 2020. Methods: All patients performed a brain computer tomography (CT) scan on their arrival and 24 hours later. Patients with or without HT were compared regarding functional 90-day outcome using the modified rankin scale (mRS). Functional disability was considered as mRS < 2. Results: 383 patients were included, mean age was 62,2 (±13,8), which 54,3% were male, 80,9% hypertensive, 33,1% diabetics and 27,2% were dyslipidemic. HT occurred in 11,5% patients (n= 44) increasing the risk of poorer functional outcome in discharge [RR= 1,47; (IC95% 1,25–1,72), in 30 days [RR = 1,54; (IC95% 1,01-1,92)], and in 90 days [RR= 1,39; (IC95% 1,01-1,92)]. Multivariate analysis HT was not associated with worse outcome in 90 days (mRS>2) [OR= 1,01; (IC95% 0,44–2,33) p= 0,987], when adjusted to age, sex, NIHSS, ASPECTS, trombolysis and other relevant variables. Conclusion: Although the occurrency of HT had been associated with worse short-term outcomes, patients seems to recover from disability over time.

scholarly journals Does hemorrhagic transformation in patients with ischemic stroke predict worse functional outcomes?

2021 ◽  
Author(s):  
Ivã Taiuan Fialho Silva ◽  
Vinícius Bessa Mendez ◽  
Fernanda Ferreira de Abreu ◽  
Alice Monteiro Soares Cajaíba ◽  
Pedro Antonio Pereira de Jesus
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Stroke Unit ◽  
Functional Disability ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Short Term ◽  
Relevant Variables ◽  
Patient Prognosis ◽  
The Impact

Background: Hemorrhagic transformation (HT) is a complication of stroke described as cause of early neurologic deterioration. Previous studies are discordant about the real impact of HT on stroke prognosis. Objectives: to describe the impact of HT in patient prognosis. Design and setting: Prospective cohort with acute ischemic stroke patients from a Stroke Unit, admitted between 2017 to 2020. Methods: All patients performed a brain computer tomography (CT) scan on their arrival and 24 hours later. Patients with or without HT were compared regarding functional 90-day outcome using the modified rankin scale (mRS). Functional disability was considered as mRS < 2. Results: 383 patients were included, mean age was 62,2 (±13,8), which 54,3% were male, 80,9% hypertensive, 33,1% diabetics and 27,2% were dyslipidemic. HT occurred in 11,5% patients (n= 44) increasing the risk of poorer functional outcome in discharge [RR= 1,47; (IC95% 1,25–1,72), in 30 days [RR = 1,54; (IC95% 1,01-1,92)], and in 90 days [RR= 1,39; (IC95% 1,01-1,92)]. Multivariate analysis HT was not associated with worse outcome in 90 days (mRS>2) [OR= 1,01; (IC95% 0,44–2,33) p= 0,987], when adjusted to age, sex, NIHSS, ASPECTS, trombolysis and other relevant variables. Conclusion: Although the occurrency of HT had been associated with worse short-term outcomes, patients seems to recover from disability over time.

Elevated total homocysteine predicts in-hospital pneumonia and poor functional outcomes in acute ischemic stroke

2020 ◽  
Author(s):  
Shoujiang You ◽  
Lixuan Wang ◽  
Huaping Du ◽  
Danni Zheng ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Fold Increase ◽  
Short Term ◽  
Thcy Level ◽  
Poor Outcome ◽  
Total Homocysteine ◽  
The Impact

Abstract Background The impact of elevated total homocysteine (tHcy) on functional outcomes and pneumonia after acute ischemic stroke (AIS) is still not well understood. We investigated the association between tHcy levels upon hospital admission and in-hospital short-term outcomes in AIS patients. Methods A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into 4 groups according to their level of admission tHcy: Q1 (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. Results During hospitalization, 332 patients (15.9%) had pneumonia, 57 patients (2.7%) died from all causes and 784 (37.6%) patients experienced poor outcome at discharge. The risk of in-hospital pneumonia was significantly higher in patients with highest tHcy level (Q4) compared to those with lowest (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P -trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality(adjusted OR 3.35; 95% CI, 1.11–10.13; P -trend =0.015) and poor outcome upon discharge(adjusted OR 1.50; 95% CI, 1.06–2.12; P -trend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. Subgroup analyses further confirmed a significant association between higher tHcy levels and a high risk of short-term outcomes. Conclusions Having a high admission tHcy level was independently associated with in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge in AIS patients. Moreover, the association between higher tHcy and poor functional outcome was not modified by pneumonia.

scholarly journals Relationship Between Homocysteine and Carotid Artery Stenosis in Ischemic Stroke

2013 ◽  
Vol 28 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Aminur Rahman ◽  
Firoz Ahmed Quraishi ◽  
Md Nurul Amin Miah ◽  
Maliha Hakim ◽  
Uttam Kumar Saha ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Homocysteine Level ◽  
Density Lipoprotein ◽  
Case Group ◽  
Healthy Controls ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Artery Disease

Background: Epidemiologic studies have identified hyper-homocysteinemia as a possible risk factor for atherosclerosis. The aim of my study was based on evaluation of relationship between homocysteinemia with carotid artery stenosis in ischemic stroke patients.Methods and materials: It was a prospective observational study conducted in the Department of Neurology, Sir Salimullah Medical College & Mitford hospital, Dhaka. Thirty six consecutive patients with ischemic stroke were analyzed by serum total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride and extracranial Doppler ultrasonography and vascular risk factors were recorded. Equal number of controls of same ages were compared with the case group.Result: Mean fasting blood sugar, serum fasting total cholesterol (TC), serum fasting Low density lipoprotein (LDL) were significantly higher in case group (p=0.001). Serum TC and LDL had a positive correlation with serum homocystine (p=0.001). Serum High density lipoprotein (HDL) had a negative correlation (p=0.718) and serum triglyceride (TG) had a negative correlation (p = 0.182). Total plasma fasting homocysteine level in case group was 21.89 ± 9.38 ìmol/l and control group was 12.31 ± 3.27 ìmol/l, (p=0.001). Elevated fasting homocysteine level was found in 75.0% of the ischemic stroke patients and in 16.67% of healthy controls (p=0.001).On the basis of clinical evaluation and results of imaging studies, etiological classification of the ischemic stroke patients were made, where 36.1% cases were small artery disease, 38.9% large artery disease, 8.3% cases cardioembolic and in 16.7 % other causes. Among the cases, carotid duplex study was found normal in seven cases (19.4%), Group 1 findings in seven cases (19.4%), group 2 findings in eight cases (22.2%), group 3 findings in thirteen cases (36.1%) and group 4 findings in one case (2.8%). All abnormal carotid duplex findings were significantly higher among cases with elevated level of homocysteine (p=0.001, 0.001, 0.001).Conclusion: The incidence of hyperhomo-cysteinemia is higher in ischaemic stroke cases than that in age-sex matched healthy controls. Hyperhomocysteinemia in ischaemic stroke patients has been determined as vascular risk factor in our study. Significant correlation has been found between homocysteine concentration and intraluminal thickness and carotid artery stenosis.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 1-9

scholarly journals Long term Post-Stroke Functional Outcomes: a comparison of diabetics and non-diabetics

2021 ◽  
Author(s):  
Deidre Anne de Silva ◽  
Kaavya Narasimhalu ◽  
Ian Wang Huang ◽  
Fung Peng Woon ◽  
John C. Allen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Age Group ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Post Stroke ◽  
The Impact

Introduction: Diabetes mellitus (DM) is known to influence outcomes in the short-term following stroke. However, the impact of DM on long-term functional outcomes after stroke is unclear. We compared functional outcomes periodically over 7 years between diabetic and non-diabetic ischemic stroke patients and investigated the impact of DM on the long-term trajectory of post-stroke functional outcomes. We also studied the influence of age on the diabetes-functional outcome association. Methods: This is a longitudinal observational cohort study of 802 acute ischemic stroke patients admitted to the Singapore General Hospital from 2005 to 2007. Functional outcomes were assessed using the modified Rankin Scale (mRS) with poor functional outcome defined as mRS≥3. Follow-up data was determined at 6 months and at median follow-up durations of 29 and 86 months. Results: Among the 802 ischemic stroke patients studied (mean age 64 ± 12 years, male 63%), 42% had DM. In regression analyses adjusting for covariates, diabetic patients were more likely to have poor functional outcomes at 6 months (OR=2.12, 95% CI: 1.23–3.67) and at median follow-up durations of 29 months (OR=1.96, 95% CI: 1.37–2.81) and 86 months (OR=2.27, 95% CI: 1.58–3.25). In addition, age modulated the effect of DM, with younger stroke patients (≤65 years) more likely to have long term poor functional outcome at the 29-month (p=0.0179) and 86-month (p=0.0144) time points. Conclusions: DM was associated with poor functional outcomes following ischemic stroke in the long term with the effect remaining consistent throughout the 7-year follow-up period. Age modified the effect of DM in the long term, with an observed increase in risk in the ≤65 age group but not in the >65 age group.

scholarly journals Phenylacetylglutamine, a Novel Biomarker in Acute Ischemic Stroke

2021 ◽  
Vol 8 ◽  
Author(s):  
Fang Yu ◽  
Xi Li ◽  
Xianjing Feng ◽  
Minping Wei ◽  
Yunfang Luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Tca Cycle ◽  
Healthy Controls ◽  
Short Term ◽  
Severe Stroke ◽  
Nihss Score ◽  
Potential Biomarker ◽  
Hormone Biosynthesis ◽  
Metabolic Biomarkers

Background: To discover novel metabolic biomarkers of ischemic stroke (IS), we carried out a two-stage metabolomic profiling of IS patients and healthy controls using untargeted and targeted metabolomic approaches.Methods: We applied untargeted liquid chromatography-mass spectrometry (LC-MS) to detect the plasma metabolomic profiles of 150 acute IS patients and 50 healthy controls. The candidate differential microbiota-derived metabolite phenylacetylglutamine (PAGln) was validated in 751 patients with IS and 200 healthy controls. We evaluated the associations between PAGln levels and the severity and functional outcomes of patients with IS. Clinical mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score 0–5, and moderate-severe stroke as NIHSS score &gt;5. A favorable outcome at 3 months after IS was defined as the modified Rankin Scale (mRS) score 0–2, and unfavorable outcome as mRS score 3–6.Results: In untargeted metabolomic analysis, we detected 120 differential metabolites between patients with IS and healthy controls. Significantly altered metabolic pathways were purine metabolism, TCA cycle, steroid hormone biosynthesis, and pantothenate and CoA biosynthesis. Elevated plasma PAGln levels in IS patients, compared with healthy controls, were observed in untargeted LC-MS analysis and confirmed by targeted quantification (median 2.0 vs. 1.0 μmol/L; p &lt; 0.001). Patients with moderate-severe stroke symptoms and unfavorable short-term outcomes also had higher levels of PAGln both in discovery and validation stage. After adjusting for potential confounders, high PAGln levels were independently associated with IS (OR = 3.183, 95% CI 1.671–6.066 for the middle tertile and OR = 9.362, 95% CI 3.797–23.083 for the highest tertile, compared with the lowest tertile) and the risk of unfavorable short-term outcomes (OR = 2.286, 95% CI 1.188–4.401 for the highest tertile).Conclusions: IS patients had higher plasma levels of PAGln than healthy controls. PAGln might be a potential biomarker for IS and unfavorable functional outcomes in patients with IS.

scholarly journals Glycated Albumin, a Novel Biomarker for Short-Term Functional Outcomes in Acute Ischemic Stroke

2021 ◽  
Vol 11 (3) ◽  
pp. 337
Author(s):  
Yerim Kim ◽  
Sang-Hwa Lee ◽  
Min Kyoung Kang ◽  
Tae Jung Kim ◽  
Han-Yeong Jeong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Glycated Hemoglobin ◽  
Prognostic Biomarker ◽  
Glycated Albumin ◽  
Short Term ◽  
Multiple Covariates ◽  
New Biomarkers ◽  
The Impact

Background: There is growing interest in the use of new biomarkers such as glycated albumin (GA), but data are limited in acute ischemic stroke. We explored the impact of GA on short-term functional outcomes as measured using the modified Rankin Scale (mRS) at 3 months compared to glycated hemoglobin (HbA1c). Methods: A total of 1163 AIS patients from two hospitals between 2016 and 2019 were included. Patients were divided into two groups according to GA levels (GA < 16% versus GA ≥ 16%). Results: A total of 518 patients (44.5%) were included in the GA ≥ 16% group. After adjusting for multiple covariates, the higher GA group (GA ≥ 16%) had a 1.4-fold risk of having unfavorable mRS (95% CI 1.02–1.847). However, HbA1c was not significantly associated with 3-month mRS. In addition, GA ≥ 16% was independently associated with unfavorable short-term outcomes only in patients without diabetes. Conclusions: In light of these results, GA level might be a novel prognostic biomarker compared to HbA1c for short-term stroke outcome. Although the impact of GA is undervalued in the current stroke guidelines, GA monitoring should be considered in addition to HbA1c monitoring.

Prestroke statin use enhances collateralization in acute ischemic stroke patients

2020 ◽  
Vol 38 (4) ◽  
pp. 311-321
Author(s):  
Jiaying Zhu ◽  
Mengmeng Ma ◽  
Jinghuan Fang ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Statin Therapy ◽  
Cerebral Artery ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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