caa a22 4500 606215050 CHVBK 20210128101057.0 cr unu---uuuuu 210128e20150301xx s 000 0 eng 10.1007/s00701-014-2297-0 doi (NATIONALLICENCE)springer-10.1007/s00701-014-2297-0 Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox? [Elektronische Daten] [Sivashanmugam Dhandapani, Sachin Goudihalli, Kanchan Mukherjee, Harnarayan Singh, Anirudh Srinivasan, Mohammad Danish, Shanthanam Mahalingam, Manju Dhandapani, Sunil Gupta, N. Khandelwal, Suresh Mathuriya] 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 3months. 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. Springer-Verlag Wien, 2014 SAH nationallicence Homocysteine nationallicence Outcome nationallicence Prognosis nationallicence Reverse epidemiology nationallicence Dhandapani Sivashanmugam Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Goudihalli Sachin Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Mukherjee Kanchan Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Singh Harnarayan Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Srinivasan Anirudh Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Danish Mohammad Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Mahalingam Shanthanam Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Dhandapani Manju National Institute of Nursing Education (NINE), Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Gupta Sunil Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Khandelwal N. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Mathuriya Suresh Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut Acta Neurochirurgica Springer Vienna 157/3(2015-03-01), 399-407 0001-6268 157:3<399 2015 157 701 https://doi.org/10.1007/s00701-014-2297-0 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2297-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Dhandapani Sivashanmugam Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Goudihalli Sachin Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Mukherjee Kanchan Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Singh Harnarayan Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Srinivasan Anirudh Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Danish Mohammad Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Mahalingam Shanthanam Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Dhandapani Manju National Institute of Nursing Education (NINE), Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Gupta Sunil Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Khandelwal N. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 700 1- Mathuriya Suresh Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), 160012, Chandigarh, India aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/3(2015-03-01), 399-407 0001-6268 157:3<399 2015 157 701