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

Fuck, we don't need predictions of pneumonia you blithering idiots, solve the problem of preventing that pneumonia in the first place.  I'd have you all fired.

You've known about this problem for a long time. GET THERE! 

Just maybe this vaccine!

• Pneumonia Vaccine (3 posts to July 2020)

 

• 11% Stroke-associated pneumonia (2 posts to October 2020)

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

Jun Peng¹, Guanghua Zhu¹, Sheng Xiao¹ and Shucheng Liu^2*

• ¹Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
• ²Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China

Background: Homocysteine (Hcy) has been extensively acknowledged to be correlated with inflammation. In this study, the relationship between Hcy and hospital-acquired pneumonia (HAP) in primary intracerebral hemorrhage (pICH) was explored.

Methods: We conducted a hospital-based study on screened eligible patients with primary intracerebral hemorrhage admitted within 24 h after symptom onset from January 2019 to June 2021. The associations between Hcy and HAP and poor outcomes in pICH were investigated using univariate and multivariate logistic regression analyses. The predictive accuracy of Hcy was assessed by the receiver operating characteristic curve and the optimal cutoff value of Hcy was determined by Youden Index. The patterns and magnitudes of associations between Hcy and HAP and poor outcomes were evaluated using a restricted cubic spline (RCS).

Results: A total of 579 patients with pICH were included in the study. Hcy level was significantly higher in patients with HAP and poor outcomes (p < 0.001). The univariate and multivariate logistic regression analyses demonstrated that elevated Hcy was independently associated with both HAP and poor outcomes (p < 0.001). Furthermore, receiver operating characteristic analysis indicated that Hcy exhibited a moderate predictive accuracy for both HAP and poor outcomes after pICH. The RCS model showed that there were linear relationships between Hcy and HAP and poor outcomes.

Conclusions: Higher Hcy level was independently associated with HAP and poor outcomes in patients with pICH.

Introduction

Intracerebral hemorrhage (ICH) remains one of the most common critical diseases in the neurological field, accompanied by a poor prognosis due to the limited treatment options (1). Patients with ICH are generally at high risk of suffering hospital-acquired pneumonia (HAP) during hospitalization, which is reported markedly correlated with poor functional outcomes and mortality (2). Accordingly, it is important to identify risk factors of HAP to improve clinical outcomes. A variety of risk factors for HAP after ICH have been identified, namely, mechanical ventilation, tube feeding, dysphagia, older age, male sex, ICH severity, heart diseases, pulmonary diseases, intubation, dysphagia, current smoking, and lymphopenia (2–5). Generally, an appropriate predictor should be both easily acquired and effectively intervened through existing management to improve the outcomes. Nevertheless, most of the current markers failed to meet these criteria. Thus, we attempt to explore an appropriate biomarker for predicting HAP after ICH.

Homocysteine (Hcy) is a sulfur-containing amino acid produced by methionine metabolism and is mainly eliminated through the kidneys. Over the last decade, a strong association between Hcy and induction of inflammatory determinants in both human and experimental models has been demonstrated (6–9). A previous study has proved that a high admission Hcy level is independently associated with HAP in patients with acute ischemic stroke (10). Based on this, we proposed the hypothesis that Hcy was an independent predictor for HAP in primary ICH.

Herein, in the present study, we explored the correlation of elevated Hcy with HAP and 3-month functional outcomes in primary ICH. Furtherly, we attempted to determine the predictive accuracy and the cut-off values of Hcy for HAP and 3-month poor outcomes after ICH.

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