Prognostic Significance of Homocysteine Levels in Acute Ischemic Stroke: A Prospective Cohort Study

Associations between hyperhomocysteinemia and prognosis of stroke were seldom explored and always indefinite. We therefore performed a study to elucidate the relationship between homocysteine levels and stroke prognosis. Between 2008 and 2013, baseline data and blood samples of acute ischemic stroke patients were collected from the Henan Province Stroke Registry. Using a prospective cohort, scheduled follow-up, and multivariable logistic regression analysis, associations among the blood homocysteine level and acute neurological impairment and outcomes, stroke recurrence, and all-cause death were investigated. Relevant cutoff homocysteine levels were determined using the area under the receiver operating characteristics curve. Of 1,460 patients, 1,342 completed the 12-month follow-up. We observed higher homocysteine levels in males, those with an advanced age, concomitant hyperlipidemia, a smoking habit, and excessive alcohol consumption. The homocysteine level was an independent risk factor for severe neurological impairment (adjusted relative risk [RR]: 1.021, 95% confidence interval [CI]: 1.004-1.037), a poor functional outcome (adjusted RR with 95% CI: 3-month, 1.029, 1.018-1.039; 6-month, 1.029, 1.018-1.039; and 12-month, 1.038, 1.027-1.049), and stroke recurrence in the large artery atherosclerosis subtype (adjusted RR: 1.025, 1.006-1.045). The optimal cutoff for severe neurological impairment was 17.64 µmol/L, and the cutoffs for poor functional outcomes were 17.28 µmol/L, 17.28 µmol/L, and 14.78 µmol/L at 3, 6, and 12 months, respectively. We found an elevated homocysteine level independently predicted severe neurological impairment, a poor functional outcome, and stroke recurrence in the large artery atherosclerosis stroke subtype. The relevant cutoff homocysteine levels also provide a reference for future clinical work.