Deans' stroke musings: The prognostic value of homocysteine levels in hemorrhagic stroke patients: a systematic review and meta-analysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, May 20, 2025

The prognostic value of homocysteine levels in hemorrhagic stroke patients: a systematic review and meta-analysis

Your competent? doctor worked a solution to this problem from July 2022, right?

Elevated Homocysteine Levels Predict Hospital-Acquired Pneumonia and Poor Functional Outcomes in Primary Intracerebral Hemorrhage July 2022

The latest here:

The prognostic value of homocysteine levels in hemorrhagic stroke patients: a systematic review and meta-analysis

Yi Zong¹

Qiaohui Gu²^*

¹Department of Emergency, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, China
²Department of Neurology, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, China

Background: Hemorrhagic stroke is associated with significant morbidity and mortality, prompting the search for modifiable risk factors and prognostic indicators. Elevated homocysteine levels have been implicated in vascular diseases, but their link to hemorrhagic stroke outcomes remains unclear. This systematic review and meta-analysis aimed to evaluate the association between homocysteine levels and outcomes in hemorrhagic stroke patients.

Methods: The MEDLINE, EMBASE, and Cochrane Central databases were searched for studies comparing the outcomes of hemorrhagic stroke in patients with high versus normal homocysteine levels. Data were pooled using random-effects models to calculate odds ratios (ORs) for mortality and poor functional outcomes and standardized mean differences (SMDs) for homocysteine levels, with respective 95% confidence intervals (CIs).

Results: The review included 10 studies. Pooled analysis showed no significant association between high homocysteine levels and increased risk of mortality (OR: 1.123, 95% CI: 0.589 to 2.143), poor functional outcomes (OR: 1.203, 95% CI: 0.962 to 1.504), or unfavorable neurological outcomes (OR: 1.001, 95% CI: 0.618 to 1.620). Substantial heterogeneity was observed among studies.

Conclusion: High homocysteine levels were not significantly associated with mortality, functional outcomes, or unfavorable neurological outcomes in hemorrhagic stroke patients. The clinical utility of homocysteine as a prognostic marker in this population remains uncertain and warrants further research.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42024527207.

Introduction

Hemorrhagic stroke is associated with particularly high mortality and morbidity rates (1). Unlike ischemic stroke, which results from blockages in blood flow to the brain, hemorrhagic stroke is caused by ruptured blood vessels, leading to blood accumulation that can cause brain cell damage (2). The management and prognosis of hemorrhagic stroke remain challenging, highlighting the need for identifying reliable prognostic markers that could guide therapeutic strategies and improve patient outcomes (3).

Recently, the potential prognostic value of homocysteine in the context of hemorrhagic stroke has become a focus of research (4, 5). Elevated homocysteine levels, a condition known as hyperhomocysteinemia, have been implicated in various pathological processes, including endothelial dysfunction, oxidative stress, and inflammatory responses, all of which can exacerbate vascular damage and contribute to the risk of hemorrhagic stroke (5, 6). Moreover, hyperhomocysteinemia is associated with other vascular risk factors, such as hypertension, diabetes, and dyslipidemia, which are prevalent among stroke patients (7–9).

The potential link between homocysteine levels and hemorrhagic stroke outcomes comes from the role of homocysteine in vascular biology. The research suggests that homocysteine may contribute to the weakening of blood vessel walls, leading to an increased propensity for rupture and bleeding within the brain (10). Elevated homocysteine levels, therefore, might not only increase the risk of stroke but also influence recovery, functional outcomes, and the likelihood of recurrent bleeding (11–13). Nevertheless, the prognostic value of homocysteine in patients with hemorrhagic stroke is still unclear. While some studies report a direct correlation between high homocysteine levels and poor post-stroke outcomes, such as higher mortality rates and severity of the condition, others fail to establish a significant association (11–13). This discrepancy could be attributed to differences in study design, population characteristics, timing of homocysteine measurement, and the heterogeneity in defining outcomes. This review aims to critically evaluate and synthesize existing research on the prognostic value of homocysteine in patients who have suffered a hemorrhagic stroke.