Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
Department of Neurology, The Affiliated Wujiang Hospital of Nantong University, Suzhou 215200, China.
Curr Neurovasc Res. 2020;17(5):745-753. doi: 10.2174/1567202617666201214111244.
We investigated the association between elevated total homocysteine (tHcy) levels upon hospital admission and short-term in-hospital outcomes, including pneumonia in acute ischemic stroke (AIS) patients.
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 four groups according to their level of admission tHcy: quartile (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.
The risk of in-hospital pneumonia was significantly higher in patients with the highest tHcy level (Q4) compared to those with the lowest tHcy level (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 (OR 3.35; 95% CI, 1.11-10.13; P-trend =0.015) and poor outcome upon discharge (OR 1.50; 95% CI, 1.06-2.12; Ptrend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia.
Having a high admission tHcy level was independently associated with in-hospital pneumonia, in-hospital mortality, and poor outcome upon discharge in AIS patients.
我们研究了入院时总同型半胱氨酸（tHcy）水平升高与急性缺血性脑卒中（AIS）患者短期院内结局（包括肺炎）之间的关系。
本研究共纳入 2013 年 12 月至 2014 年 5 月苏州 22 家医院的 2084 例 AIS 患者。根据入院时 tHcy 水平，我们将患者分为四组：四分位数（Q1）（<9.70μmol/L）、Q2（9.70-12.3μmol/L）、Q3（12.3-16.9μmol/L）和 Q4（≥16.9μmol/L）。使用逻辑回归模型估计 tHcy 对 AIS 患者短期结局（包括院内肺炎、全因院内死亡率和出院时不良结局[改良 Rankin 量表评分≥3]）的影响。
与 tHcy 最低水平（Q1）患者相比，tHcy 最高水平（Q4）患者院内肺炎的风险显著增加（调整后的优势比[OR]1.55；95%置信区间[CI]1.03-2.33；P 趋势=0.019）。与 Q1 相比，tHcy 最高水平（Q4）与院内死亡率（OR 3.35；95%CI，1.11-10.13；P 趋势=0.015）和出院时不良结局（OR 1.50；95%CI，1.06-2.12；Ptrend=0.044）的风险分别增加 3.35 倍和 1.50 倍。在调整包括肺炎在内的潜在混杂因素后，这些关联仍然存在。
入院时 tHcy 水平较高与 AIS 患者院内肺炎、院内死亡率和出院时不良结局独立相关。
