Abstract
Backgroud: Trimethylamine N-oxide (TMAO) is produced by gut microbiota. Gut microbiota derived TMAO are known to be associated with coronary heart disease, congestive heart failure, and chronic kidney disease. Therefore, increased TMAO may be associated stroke outcome. Method: Fasting blood from consecutive 313 stroke patients were analyzed. Plasma TMAO level was measured by mass spectrometry. The patients were followed up for 3 years and major adverse cardiovascular event (MACE) was captured. The cut off value was calculated by Contal & O'Quigley's method. Results: Median TMAO level was 362.4 (IQR 317.5 - 405.6) ng/ml. Cut off value was 563. 25. Older age, men was predominant in patients with higher TMAO level. Moderate to severe renal disease were frequent and creatinine levels were high in patient with higher TMAO group compared to lower TMAO group (1.4±1.8 vs. 0.9 ± 1.1, p = 0.047). Higher level of TMAO was associated with occurrence of MACE in Kaplan-Meier survival analysis (log-rank test, p<0.01). Multivariable Cox regression analysis showed that TMAO level was independent factor along with age, sex, hypertension, diabetes, and initial stroke severity (HR 1.712, 96% CI 1.060 - 2.767). Conclusion: We found that the TMAO level in patients with acute ischemic stroke was associated with poor long-term outcome. Gut microbiota and brain axis may be a prognostic marker after acute ischemic stroke.
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