Prognostic Significance of Homocysteine Level on Neurological Outcome in Brain Arteriovenous Malformations.

Fa Lin,Dong Zhang,Shuo Wang,Chaofan Zeng,Peicong Ge,Jizong Zhao

doi:10.1155/2020/6661475

Abstract

Objective We aimed to investigate the serum homocysteine (Hcy) level in patients with brain arteriovenous malformation (bAVM) and their impact on neurological outcome during hospitalization. Method We retrospectively reviewed patients diagnosed with bAVMs in Beijing Tiantan Hospital from January 2019 to August 2020. Patients were divided into two groups according to the mRS (modified Rankin Scale) score at discharge. Clinical and laboratory characteristics were compared. Logistic regression analyses were performed to identify the potential risk factors for short-term neurological outcome. Results A total of 175 bAVM patients were enrolled in the study, including 139 patients with favorable outcome (mRS ≤ 2) and 36 patients with unfavorable outcome (mRS > 2). Hyperhomocysteinemia was identified in 32.6% of cases (n = 57). Serum Hcy level was related to seizure manifestation (P = 0.034) and short-term neurological outcome (P = 0.027). Logistic regression analysis showed that serum glucose (OR 1.897, 95% CI 1.115-3.229; P = 0.018) and Hcy level (OR 0.838, 95% CI 0.720-0.976; P = 0.023) were significantly associated with short-term disability. Conclusion Our results indicated that the lower serum Hcy level is strongly associated with in-hospital unfavorable outcome. Further prospective studies of Hcy natural history and managements in bAVMs are required, which would be valuable for evaluating the disease-modifying efficacy of oral nutritional supplements in bAVM patients.

Highlights

Brain arteriovenous malformations are well known as congenitally abnormal conglomerations of dilated feeding arteries and draining veins without intervening capillary beds [1, 2]
Among 402 patients with cerebral vascular malformations admitted to our hospital between January 2019 and August 2020, 332 patients were diagnosed with brain arteriovenous malformation (bAVM) using digital subtraction angiography (DSA) or magnetic resonance imaging (MRI)
After excluding 34 cavernous malformations and 193 patients with incomplete data, a total of 175 bAVM patients were enrolled in our study (Figure 1)

Summary

Introduction

Brain arteriovenous malformations (bAVMs) are well known as congenitally abnormal conglomerations of dilated feeding arteries and draining veins without intervening capillary beds [1, 2]. BAVM occurs in approximately 15/100,000 persons, it is still the leading cause of hemorrhagic stroke in young people and often results in a high incidence of neurological morbidity and mortality [2]. Prediction of outcomes is mostly based on demographic, clinical, and radiographic markers, while the information on routine laboratory examinations is inadvertently ignored. Previous studies have focused on hemorrhagic stroke and unfavorable outcomes [5, 6]. Some studies suggested that Hcy disorders and hemorrhagic bAVMs shared similar underlying mechanisms in terms of hemodynamics [7,8,9] and molecular abnormalities [10,11,12,13,14]. The above-mentioned studies were based on other hemorrhagic subtypes and animal experiments; the clinical significance of Hcy in patients with bAVM has not been discussed yet

Methods

Results

Conclusion