Abstract
BackgroundDelayed cerebral ischemia (DCI) is a primary cause of poor prognosis after aneurysmal subarachnoid hemorrhage (aSAH) and needs close medical attention in clinical practice. Homocysteine (Hcy) has been implicated in cerebrovascular diseases. This study aimed to investigate whether serum Hcy could help to predict the occurrence of DCI in aSAH patients, and compare its diagnostic value with traditional methods.MethodsWe enrolled 241 aSAH patients in this study. Serum Hcy levels were collected from each patient. The baseline information was reviewed and analyzed. The binary logistic regression was used to explore the relation of serum Hcy levels with occurrence of DCI, and diagnostic performance of serum Hcy for predicting DCI was evaluated using a receiver operating characteristic (ROC) curve.ResultsThe admission serum Hcy levels were found significantly higher in aSAH patients with DCI than those without (P < 0.001). The serum Hcy levels were positively correlated with the World Federation of Neurosurgical Societies (WFNS) scores, modified Fisher scores as well as Hunt and Hess scores at admission. Multivariate analysis revealed that occurrence of DCI was associated with serum Hcy levels (Odds Ratio [OR] = 1.257; 95% Confidence Interval [CI], 1.133–1.396, P < 0.001), modified Fisher scores (OR = 1.871; 95%CI, 1.111–3.150, P = 0.018) and Hunt and Hess scores (OR = 2.581; 95%CI, 1.222–5.452, P = 0.013) after adjusting for the significant variables in univariate analysis. Meanwhile, serum Hcy levels achieved good performance for DCI prediction (area under the curve [AUC], 0.781; 95%CI, 0.723–0.831, P < 0.001).ConclusionSerum homocysteine might have the potential to be a useful and cost-effective biomarker for predicting the occurrence of DCI in aSAH patients.
Highlights
Aneurysmal subarachnoid hemorrhage causes instantaneously severe damage to patients and results in a series of neurological dysfunctions in the later days [1]
The serum Hcy levels were positively correlated with the World Federation of Neurosurgical Societies (WFNS) scores, modified Fisher scores as well as Hunt and Hess scores at admission
Multivariate analysis revealed that occurrence of Delayed cerebral ischemia (DCI) was associated with serum Hcy levels (Odds Ratio [OR] = 1.257; 95% Confidence Interval [CI], 1.133–1.396, P < 0.001), modified Fisher scores (OR = 1.871; 95%CI, 1.111–3.150, P = 0.018) and Hunt and Hess scores (OR = 2.581; 95%CI, 1.222–5.452, P = 0.013) after adjusting for the significant variables in univariate analysis
Summary
Aneurysmal subarachnoid hemorrhage (aSAH) causes instantaneously severe damage to patients and results in a series of neurological dysfunctions in the later days [1]. Delayed cerebral ischemia (DCI) as a primary cause of adverse outcomes after aSAH is characterized by the occurrence of focal neurological deficits that were not manifested on initial imaging. Ji et al [12] found that HHcy is predictive of severe neurological impairments or other poor functional outcomes in patients with acute ischemic stroke. Delayed cerebral ischemia (DCI) is a primary cause of poor prognosis after aneurysmal subarachnoid hemorrhage (aSAH) and needs close medical attention in clinical practice. This study aimed to investigate whether serum Hcy could help to predict the occurrence of DCI in aSAH patients, and compare its diagnostic value with traditional methods
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