Frenger Johannes, Jeker Benjamin, Arnold Markus, Grosse Gerrit M, Pokorny Thomas, Westphal Laura P, Inauen Corinne, Bicciato Giulio, Arnold Marcel, Fischer Urs, De Marchis Gian Marco, Kägi Georg, Kahles Timo, Cereda Carlo W, Bustamante Alejandro, Montaner Joan, Ntaios George, Foerch Christian, Spanaus Katharina, von Eckardstein Arnold, Mueller Daniel, Katan Mira
Department of Neurology & Stroke Center, University Hospital of Basel & University of Basel, Basel, Switzerland.
Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
Eur Stroke J. 2025 Sep 7:23969873251366192. doi: 10.1177/23969873251366192.
Recent studies in stroke patients from predominantly Asian populations have underscored the significance of trimethylamine N-oxide (TMAO) as a valuable blood biomarker for predicting incident strokes and major adverse cardiovascular events (MACE). However, its prognostic role after ischemic stroke in other populations is not yet comprehensively investigated.
We measured plasma TMAO levels in 1726 acute ischemic stroke patients (within 24 h from symptom onset) from the multicenter BIOSIGNAL cohort. Using cox and logistic regression models adjusting for demographic and vascular risk factors, we investigated the association of TMAO with recurrent stroke, MACE within 365 days and functional outcome at 90 days after stroke.
TMAO levels were not associated with any risk of recurrent stroke ( = 108, unadj. HR per unit increase of log (TMAO) 1.15, 95% CI 0.88-1.51, adjust. HR 1.07, 95% CI 0.78-1.47) or MACE ( = 309, unadj. HR of log (TMAO) 1.10,95% CI 0.91-1.3, adjust. HR 0.90, 95% CI 0.74-1.09). There was an univariable positive association between higher TMAO plasma levels and unfavorable functional outcome, this association remained statistically significant in the multivariable analysis (unadj. OR of log (TMAO) 1.56, 95% CI 1.34-1.81, adjust. OR 1.28, 95% CI 1.04-1.57).
In this large cohort of acute stroke patients from a predominantly White population, TMAO had no independent association with either recurrent stroke, or MACE or death. In univariable, and multivariable analysis, there was a significant association between TMAO and unfavorable functional outcome, which might not be clinically significant due to its low effect size. Therefore, TMAO seems not to be a clinically relevant biomarker for risk stratification after stroke.
最近针对主要为亚洲人群的中风患者开展的研究强调了氧化三甲胺（TMAO）作为预测中风事件和主要不良心血管事件（MACE）的重要血液生物标志物的意义。然而，其在其他人群缺血性中风后的预后作用尚未得到全面研究。
我们在多中心BIOSIGNAL队列的1726例急性缺血性中风患者（症状发作后24小时内）中测量了血浆TMAO水平。使用调整了人口统计学和血管危险因素的Cox和逻辑回归模型，我们研究了TMAO与复发性中风、365天内的MACE以及中风后90天的功能结局之间的关联。
TMAO水平与复发性中风的任何风险均无关联（n = 108，未调整的log（TMAO）每单位增加的HR为1.15，95%CI为0.88 - 1.51，调整后的HR为1.07，95%CI为0.78 - 1.47）或MACE（n = 309，未调整的log（TMAO）的HR为1.10，95%CI为0.91 - 1.3，调整后的HR为0.90，95%CI为0.74 - 1.09）。较高的血浆TMAO水平与不良功能结局之间存在单变量正相关，在多变量分析中这种关联仍具有统计学意义（未调整的log（TMAO）的OR为1.56，95%CI为1.34 - 1.81，调整后的OR为1.28，95%CI为1.04 - 1.57）。
在这个主要为白人的急性中风患者大队列中，TMAO与复发性中风、MACE或死亡均无独立关联。在单变量和多变量分析中，TMAO与不良功能结局之间存在显著关联，但由于其效应量较低，可能在临床上不具有显著意义。因此，TMAO似乎不是中风后风险分层的临床相关生物标志物。
