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Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox?
Background Homocysteine (tHcy) has been known over the last few decades for its putative impact on vascular diseases, but has not been evaluated much in patients with subarachnoid hemorrhage (SAH). This study was carried out to assess its prognostic impact on the neurological outcome following SAH....
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| Published in: | Acta neurochirurgica 2015-03, Vol.157 (3), p.399-407 |
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| creator | Dhandapani, Sivashanmugam Goudihalli, Sachin Mukherjee, Kanchan K. Singh, Harnarayan Srinivasan, Anirudh Danish, Mohammad Mahalingam, Shanthanam Dhandapani, Manju Gupta, Sunil K. Khandelwal, N. Mathuriya, Suresh N. |
| description | Background
Homocysteine (tHcy) has been known over the last few decades for its putative impact on vascular diseases, but has not been evaluated much in patients with subarachnoid hemorrhage (SAH). This study was carried out to assess its prognostic impact on the neurological outcome following SAH.
Methods
Admission plasma tHcy was evaluated in 90 SAH patients and prospectively studied in relation to various factors and the Glasgow Outcome Scale (GOS) at 3 months. Univariate and multivariate analyses were performed using SPSS 21.
Results
tHcy was significantly higher following SAH compared to matched controls [median (IQR): 25.7 (17.3–35.9) vs. 14.0 (9.8–17.6) μmol/l,
p
|
| doi_str_mv | 10.1007/s00701-014-2297-0 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1664217020</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3597048091</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-6cc7e6f56761431f03ae49601f2eb91c663d436a90a82d1ca760f3bc08080ae3</originalsourceid><addsrcrecordid>eNqNkttqFTEUhoMotlYfwBsJeOPNaE6T7PFGSvEEBb3ofcgka_akZJIxmWm7X82nM-OuIoIggZzWt_4c1o_Qc0peU0LUm1I7QhtCRcNYpxryAJ2STrCmduRhnZMalUzuTtCTUq7riinBH6MT1raUSCFP0fevOZUZ7OJvAJdldQecBryMgG3KGYJZfIq4h-UWIGLjJl_KtjMHUyaDxzQleygL-Ag4wA2Egk10OMKaU0h7b03AaV1smgAPKYR06-Mel7U32dgxJu_wCFM9ajR7eIvPsTVlI_PPO-SqmOsaZu9g8pviAc811aW7d0_Ro8GEAs_uxzN09eH91cWn5vLLx88X55eNFXy3NNJaBXJopZJUcDoQbkB0ktCBQd9RKyV3gkvTEbNjjlqjJBl4b8muNgP8DL06ys45fVuhLLr-gYUQTIS0Fk2lFIwqwsh_oK3ijCshKvryL_Q6rTnWd2yUZK2klFaKHilbq1QyDHrOfjL5oCnRmwX00QK6WkBvFtDbJV7cK6_9BO53xq-aV4AdgVJDcQ_5j6P_qfoDobS_0A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1656256111</pqid></control><display><type>article</type><title>Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox?</title><source>Springer Nature</source><creator>Dhandapani, Sivashanmugam ; Goudihalli, Sachin ; Mukherjee, Kanchan K. ; Singh, Harnarayan ; Srinivasan, Anirudh ; Danish, Mohammad ; Mahalingam, Shanthanam ; Dhandapani, Manju ; Gupta, Sunil K. ; Khandelwal, N. ; Mathuriya, Suresh N.</creator><creatorcontrib>Dhandapani, Sivashanmugam ; Goudihalli, Sachin ; Mukherjee, Kanchan K. ; Singh, Harnarayan ; Srinivasan, Anirudh ; Danish, Mohammad ; Mahalingam, Shanthanam ; Dhandapani, Manju ; Gupta, Sunil K. ; Khandelwal, N. ; Mathuriya, Suresh N.</creatorcontrib><description>Background
Homocysteine (tHcy) has been known over the last few decades for its putative impact on vascular diseases, but has not been evaluated much in patients with subarachnoid hemorrhage (SAH). This study was carried out to assess its prognostic impact on the neurological outcome following SAH.
Methods
Admission plasma tHcy was evaluated in 90 SAH patients and prospectively studied in relation to various factors and the Glasgow Outcome Scale (GOS) at 3 months. Univariate and multivariate analyses were performed using SPSS 21.
Results
tHcy was significantly higher following SAH compared to matched controls [median (IQR): 25.7 (17.3–35.9) vs. 14.0 (9.8–17.6) μmol/l,
p
< 0.001]. It was significantly higher in younger patients. However, systemic disease, WFNS and Fisher grades did not have a significant impact on its levels. tHcy was significantly lower among patients who died [median (IQR): 16.0 (14.4–20.6) vs. 29.7 (21.8–40.2) μmol/l,
p
< 0.001] and those with unfavorable outcome (GOS 1–3) [median (IQR): 21.6 (14.5–28.2) vs. 30.3 (20.4–40.7) μmol/l,
p
= 0.004] compared to others, with a significant continuous positive correlation between tHcy and GOS (
p
= 0.002). The beneficial association of tHcy with outcome was homogeneous with no significant subgroup difference. Multivariate analysis using binary logistic regression adjusting for the effects of age, systemic disease, WFNS grade, Fisher grade, site of aneurysm, clipping or coiling revealed higher tHcy to have a significant independent association with both survival (
p
= 0.01) and favorable outcome (
p
= 0.04).
Conclusions
Higher homocysteine levels following SAH appear to have a significant association with both survival and favorable neurological outcome, independent of other known prognostic factors, apparently exemplifying “reverse epidemiology paradox” in which a conventional risk factor seems to impart a survival advantage.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-014-2297-0</identifier><identifier>PMID: 25510646</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Adult ; Aged ; Clinical Article - Vascular ; Female ; Glasgow Outcome Scale ; Homocysteine - blood ; Humans ; Interventional Radiology ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Multivariate Analysis ; Neurology ; Neuroradiology ; Neurosurgery ; Prognosis ; Prospective Studies ; Risk Factors ; Subarachnoid Hemorrhage - blood ; Subarachnoid Hemorrhage - diagnosis ; Subarachnoid Hemorrhage - epidemiology ; Surgical Orthopedics</subject><ispartof>Acta neurochirurgica, 2015-03, Vol.157 (3), p.399-407</ispartof><rights>Springer-Verlag Wien 2014</rights><rights>Springer-Verlag Wien 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-6cc7e6f56761431f03ae49601f2eb91c663d436a90a82d1ca760f3bc08080ae3</citedby><cites>FETCH-LOGICAL-c438t-6cc7e6f56761431f03ae49601f2eb91c663d436a90a82d1ca760f3bc08080ae3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25510646$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhandapani, Sivashanmugam</creatorcontrib><creatorcontrib>Goudihalli, Sachin</creatorcontrib><creatorcontrib>Mukherjee, Kanchan K.</creatorcontrib><creatorcontrib>Singh, Harnarayan</creatorcontrib><creatorcontrib>Srinivasan, Anirudh</creatorcontrib><creatorcontrib>Danish, Mohammad</creatorcontrib><creatorcontrib>Mahalingam, Shanthanam</creatorcontrib><creatorcontrib>Dhandapani, Manju</creatorcontrib><creatorcontrib>Gupta, Sunil K.</creatorcontrib><creatorcontrib>Khandelwal, N.</creatorcontrib><creatorcontrib>Mathuriya, Suresh N.</creatorcontrib><title>Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox?</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Background
Homocysteine (tHcy) has been known over the last few decades for its putative impact on vascular diseases, but has not been evaluated much in patients with subarachnoid hemorrhage (SAH). This study was carried out to assess its prognostic impact on the neurological outcome following SAH.
Methods
Admission plasma tHcy was evaluated in 90 SAH patients and prospectively studied in relation to various factors and the Glasgow Outcome Scale (GOS) at 3 months. Univariate and multivariate analyses were performed using SPSS 21.
Results
tHcy was significantly higher following SAH compared to matched controls [median (IQR): 25.7 (17.3–35.9) vs. 14.0 (9.8–17.6) μmol/l,
p
< 0.001]. It was significantly higher in younger patients. However, systemic disease, WFNS and Fisher grades did not have a significant impact on its levels. tHcy was significantly lower among patients who died [median (IQR): 16.0 (14.4–20.6) vs. 29.7 (21.8–40.2) μmol/l,
p
< 0.001] and those with unfavorable outcome (GOS 1–3) [median (IQR): 21.6 (14.5–28.2) vs. 30.3 (20.4–40.7) μmol/l,
p
= 0.004] compared to others, with a significant continuous positive correlation between tHcy and GOS (
p
= 0.002). The beneficial association of tHcy with outcome was homogeneous with no significant subgroup difference. Multivariate analysis using binary logistic regression adjusting for the effects of age, systemic disease, WFNS grade, Fisher grade, site of aneurysm, clipping or coiling revealed higher tHcy to have a significant independent association with both survival (
p
= 0.01) and favorable outcome (
p
= 0.04).
Conclusions
Higher homocysteine levels following SAH appear to have a significant association with both survival and favorable neurological outcome, independent of other known prognostic factors, apparently exemplifying “reverse epidemiology paradox” in which a conventional risk factor seems to impart a survival advantage.</description><subject>Adult</subject><subject>Aged</subject><subject>Clinical Article - Vascular</subject><subject>Female</subject><subject>Glasgow Outcome Scale</subject><subject>Homocysteine - blood</subject><subject>Humans</subject><subject>Interventional Radiology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgery</subject><subject>Multivariate Analysis</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Subarachnoid Hemorrhage - blood</subject><subject>Subarachnoid Hemorrhage - diagnosis</subject><subject>Subarachnoid Hemorrhage - epidemiology</subject><subject>Surgical Orthopedics</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqNkttqFTEUhoMotlYfwBsJeOPNaE6T7PFGSvEEBb3ofcgka_akZJIxmWm7X82nM-OuIoIggZzWt_4c1o_Qc0peU0LUm1I7QhtCRcNYpxryAJ2STrCmduRhnZMalUzuTtCTUq7riinBH6MT1raUSCFP0fevOZUZ7OJvAJdldQecBryMgG3KGYJZfIq4h-UWIGLjJl_KtjMHUyaDxzQleygL-Ag4wA2Egk10OMKaU0h7b03AaV1smgAPKYR06-Mel7U32dgxJu_wCFM9ajR7eIvPsTVlI_PPO-SqmOsaZu9g8pviAc811aW7d0_Ro8GEAs_uxzN09eH91cWn5vLLx88X55eNFXy3NNJaBXJopZJUcDoQbkB0ktCBQd9RKyV3gkvTEbNjjlqjJBl4b8muNgP8DL06ys45fVuhLLr-gYUQTIS0Fk2lFIwqwsh_oK3ijCshKvryL_Q6rTnWd2yUZK2klFaKHilbq1QyDHrOfjL5oCnRmwX00QK6WkBvFtDbJV7cK6_9BO53xq-aV4AdgVJDcQ_5j6P_qfoDobS_0A</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Dhandapani, Sivashanmugam</creator><creator>Goudihalli, Sachin</creator><creator>Mukherjee, Kanchan K.</creator><creator>Singh, Harnarayan</creator><creator>Srinivasan, Anirudh</creator><creator>Danish, Mohammad</creator><creator>Mahalingam, Shanthanam</creator><creator>Dhandapani, Manju</creator><creator>Gupta, Sunil K.</creator><creator>Khandelwal, N.</creator><creator>Mathuriya, Suresh N.</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150301</creationdate><title>Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox?</title><author>Dhandapani, Sivashanmugam ; Goudihalli, Sachin ; Mukherjee, Kanchan K. ; Singh, Harnarayan ; Srinivasan, Anirudh ; Danish, Mohammad ; Mahalingam, Shanthanam ; Dhandapani, Manju ; Gupta, Sunil K. ; Khandelwal, N. ; Mathuriya, Suresh N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-6cc7e6f56761431f03ae49601f2eb91c663d436a90a82d1ca760f3bc08080ae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Clinical Article - Vascular</topic><topic>Female</topic><topic>Glasgow Outcome Scale</topic><topic>Homocysteine - blood</topic><topic>Humans</topic><topic>Interventional Radiology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgery</topic><topic>Multivariate Analysis</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Subarachnoid Hemorrhage - blood</topic><topic>Subarachnoid Hemorrhage - diagnosis</topic><topic>Subarachnoid Hemorrhage - epidemiology</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhandapani, Sivashanmugam</creatorcontrib><creatorcontrib>Goudihalli, Sachin</creatorcontrib><creatorcontrib>Mukherjee, Kanchan K.</creatorcontrib><creatorcontrib>Singh, Harnarayan</creatorcontrib><creatorcontrib>Srinivasan, Anirudh</creatorcontrib><creatorcontrib>Danish, Mohammad</creatorcontrib><creatorcontrib>Mahalingam, Shanthanam</creatorcontrib><creatorcontrib>Dhandapani, Manju</creatorcontrib><creatorcontrib>Gupta, Sunil K.</creatorcontrib><creatorcontrib>Khandelwal, N.</creatorcontrib><creatorcontrib>Mathuriya, Suresh N.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhandapani, Sivashanmugam</au><au>Goudihalli, Sachin</au><au>Mukherjee, Kanchan K.</au><au>Singh, Harnarayan</au><au>Srinivasan, Anirudh</au><au>Danish, Mohammad</au><au>Mahalingam, Shanthanam</au><au>Dhandapani, Manju</au><au>Gupta, Sunil K.</au><au>Khandelwal, N.</au><au>Mathuriya, Suresh N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox?</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>157</volume><issue>3</issue><spage>399</spage><epage>407</epage><pages>399-407</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Background
Homocysteine (tHcy) has been known over the last few decades for its putative impact on vascular diseases, but has not been evaluated much in patients with subarachnoid hemorrhage (SAH). This study was carried out to assess its prognostic impact on the neurological outcome following SAH.
Methods
Admission plasma tHcy was evaluated in 90 SAH patients and prospectively studied in relation to various factors and the Glasgow Outcome Scale (GOS) at 3 months. Univariate and multivariate analyses were performed using SPSS 21.
Results
tHcy was significantly higher following SAH compared to matched controls [median (IQR): 25.7 (17.3–35.9) vs. 14.0 (9.8–17.6) μmol/l,
p
< 0.001]. It was significantly higher in younger patients. However, systemic disease, WFNS and Fisher grades did not have a significant impact on its levels. tHcy was significantly lower among patients who died [median (IQR): 16.0 (14.4–20.6) vs. 29.7 (21.8–40.2) μmol/l,
p
< 0.001] and those with unfavorable outcome (GOS 1–3) [median (IQR): 21.6 (14.5–28.2) vs. 30.3 (20.4–40.7) μmol/l,
p
= 0.004] compared to others, with a significant continuous positive correlation between tHcy and GOS (
p
= 0.002). The beneficial association of tHcy with outcome was homogeneous with no significant subgroup difference. Multivariate analysis using binary logistic regression adjusting for the effects of age, systemic disease, WFNS grade, Fisher grade, site of aneurysm, clipping or coiling revealed higher tHcy to have a significant independent association with both survival (
p
= 0.01) and favorable outcome (
p
= 0.04).
Conclusions
Higher homocysteine levels following SAH appear to have a significant association with both survival and favorable neurological outcome, independent of other known prognostic factors, apparently exemplifying “reverse epidemiology paradox” in which a conventional risk factor seems to impart a survival advantage.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>25510646</pmid><doi>10.1007/s00701-014-2297-0</doi><tpages>9</tpages></addata></record> |
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| ispartof | Acta neurochirurgica, 2015-03, Vol.157 (3), p.399-407 |
| issn | 0001-6268 0942-0940 |
| language | eng |
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| source | Springer Nature |
| subjects | Adult Aged Clinical Article - Vascular Female Glasgow Outcome Scale Homocysteine - blood Humans Interventional Radiology Male Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgery Multivariate Analysis Neurology Neuroradiology Neurosurgery Prognosis Prospective Studies Risk Factors Subarachnoid Hemorrhage - blood Subarachnoid Hemorrhage - diagnosis Subarachnoid Hemorrhage - epidemiology Surgical Orthopedics |
| title | Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox? |
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