PMID- 35672911
OWN - NLM
STAT- MEDLINE
DCOM- 20230223
LR  - 20230512
IS  - 1747-4949 (Electronic)
IS  - 1747-4930 (Linking)
VI  - 18
IP  - 3
DP  - 2023 Mar
TI  - Low estimated glomerular filtration rate explains the association between 
      hyperhomocysteinemia and in-hospital mortality among patients with ischemic 
      stroke/transient ischemic attack or intracerebral hemorrhage: Results from the 
      Chinese Stroke Center Alliance.
PG  - 354-363
LID - 10.1177/17474930221108278 [doi]
AB  - OBJECTIVES: To investigate the association between hyperhomocysteinemia (HHcy) 
      and in-hospital mortality following ischemic stroke (IS), transient ischemic 
      attack (TIA), or intracerebral hemorrhage (ICH). METHODS: Data on patients with 
      ischemic cerebrovascular disease (IS/TIA) or ICH enrolled in the Chinese Stroke 
      Center Alliance (CSCA) from 2015 to 2019 were extracted. Patient characteristics 
      and in-hospital mortality were analyzed and multiple adjusted logistic regression 
      analyses performed to investigate the association between blood tHcy (total 
      homocysteine) and in-hospital mortality in patients with HHcy (tHcy ⩾ 15 micromol) 
      and patients with normohomocysteinemia (nHcy) (tHcy < 15 micromol). RESULTS: A total 
      of 823,622 participants were included. Mean (SD) age was 65.9 (12.1), and 62.5% 
      (n = 514,888) were male. A total of 379,807 (46.0%) patients were identified as 
      having HHcy, and 70,364 (8.5%) patients had an estimated glomerular filtration 
      rate (eGFR) < 60 mL/min/1.73 m(2). An eGFR < 60 mL/min/1.73 m(2) was the 
      strongest independent risk factor for HHcy in both patients with IS/TIA (adjusted 
      odds ratio (aOR) 2.67, 95% confidence interval (CI): 2.49-2.86), and those with 
      ICH (2.94, 2.46-3.50). On multivariable logistic regression, after adjusting for 
      potential confounding factors, HHcy was associated with in-hospital mortality 
      (aOR: 1.25, 95% CI: 1.13-1.37 for patients with IS/TIA; aOR: 1.40, 95% CI: 
      1.12-1.76 for patients with ICH). However, after additionally adjusting for eGFR, 
      this association disappeared among patients with both IS/TIA (aOR: 1.09, 95% CI: 
      0.99-1.20) and those with ICH (aOR: 1.17, 9% CI: 0.96-1.43). CONCLUSION: HHcy was 
      associated with in-hospital mortality among the patients with IS/TIA or ICH but 
      this association disappeared after controlling for eGFR, suggesting HHcy was 
      acting as a marker of poor renal function which itself was the predictor of poor 
      outcome. Our results suggest the prevention and management of renal impairment 
      may be an important measure in the reduction of mortality in patients with HHcy 
      after IS/TIA or ICH.
FAU - Liu, Wei
AU  - Liu W
AUID- ORCID: 0000-0001-5558-4232
AD  - China National Clinical Research Center for Neurological Diseases, Beijing 
      Tiantan Hospital, Capital Medical University, Beijing, China.
FAU - Ma, Xue-Lian
AU  - Ma XL
AD  - Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital 
      Medical University, Beijing, China.
FAU - Gu, Hong-Qiu
AU  - Gu HQ
AUID- ORCID: 0000-0003-1608-1856
AD  - China National Clinical Research Center for Neurological Diseases, Beijing 
      Tiantan Hospital, Capital Medical University, Beijing, China.
AD  - National Center for Healthcare Quality Management in Neurological Diseases, 
      Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
FAU - Li, Hao
AU  - Li H
AD  - China National Clinical Research Center for Neurological Diseases, Beijing 
      Tiantan Hospital, Capital Medical University, Beijing, China.
FAU - Li, Zi-Xiao
AU  - Li ZX
AD  - China National Clinical Research Center for Neurological Diseases, Beijing 
      Tiantan Hospital, Capital Medical University, Beijing, China.
AD  - National Center for Healthcare Quality Management in Neurological Diseases, 
      Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
FAU - Wang, Yong-Jun
AU  - Wang YJ
AUID- ORCID: 0000-0002-9976-2341
AD  - China National Clinical Research Center for Neurological Diseases, Beijing 
      Tiantan Hospital, Capital Medical University, Beijing, China.
AD  - National Center for Healthcare Quality Management in Neurological Diseases, 
      Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
AD  - Department of Neurology, Beijing Tiantan Hospital, Beijing, China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220722
PL  - United States
TA  - Int J Stroke
JT  - International journal of stroke : official journal of the International Stroke 
      Society
JID - 101274068
SB  - IM
MH  - Female
MH  - Humans
MH  - Male
MH  - Cerebral Hemorrhage/complications
MH  - East Asian People
MH  - Glomerular Filtration Rate
MH  - Hospital Mortality
MH  - *Hyperhomocysteinemia/complications/epidemiology
MH  - *Ischemic Attack, Transient/complications/epidemiology
MH  - *Ischemic Stroke
MH  - Risk Factors
MH  - *Stroke
MH  - Middle Aged
MH  - Aged
OTO - NOTNLM
OT  - HHcy
OT  - Stroke
OT  - glomerular filtration rate
OT  - mortality
EDAT- 2022/06/09 06:00
MHDA- 2023/02/25 06:00
CRDT- 2022/06/08 00:52
PHST- 2022/06/09 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2022/06/08 00:52 [entrez]
AID - 10.1177/17474930221108278 [doi]
PST - ppublish
SO  - Int J Stroke. 2023 Mar;18(3):354-363. doi: 10.1177/17474930221108278. Epub 2022 
      Jul 22.