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Admission Homocysteine as a Potential Predictor for Delayed Cerebral Ischemia After Aneurysmal Subarachnoid
Tiesong Zhang1, Luyuan Zhang1, Kehui Nie2
1Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
Insights
Serum homocysteine (Hcy) levels can help predict delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Higher Hcy levels are associated with increased DCI risk, offering a potential new diagnostic biomarker.
Area of Science:
- Neurology
- Biomarkers
- Vascular Surgery
Background:
- Delayed cerebral ischemia (DCI) is a major cause of poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH).
- Homocysteine (Hcy) is implicated in cerebrovascular diseases, suggesting a potential role in aSAH complications.
Purpose of the Study:
- To investigate serum Hcy as a predictor of DCI in aSAH patients.
- To compare the diagnostic value of serum Hcy with existing methods for DCI prediction.
Main Methods:
- 241 aSAH patients were enrolled, with serum Hcy levels measured upon admission.
- Binary logistic regression and receiver operating characteristic (ROC) curve analysis were used to assess the relationship between Hcy and DCI, and its predictive performance.
Main Results:
- Admission serum Hcy levels were significantly higher in aSAH patients who developed DCI (P < 0.001).
- Serum Hcy levels showed a positive correlation with neurological severity scores (WFNS, modified Fisher, Hunt and Hess).
- Multivariate analysis confirmed Hcy as an independent predictor of DCI (OR = 1.257, P < 0.001), with an AUC of 0.781 for prediction.
Conclusions:
- Serum homocysteine demonstrates potential as a valuable and cost-effective biomarker for predicting DCI in aSAH patients.
- This finding may lead to improved early detection and management of DCI in this patient population.
Background:
Delayed 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.
Methods:
We 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.
Results:
The 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).
Conclusion:
Serum homocysteine might have the potential to be a useful and cost-effective biomarker for predicting the occurrence of DCI in aSAH patients.
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