Role of Serum Homocysteine and Outcome in Patients With Traumatic Brain Injury

Humayoun Amini; Hewad Hewadmal; Sayed Farhad Rasuli; Chowdhury S Shahriar; Abdul Fattah; Hariharan Kavanoor Sridhar; Marjan Khan; Sadaf Bhat; Abdul Subhan Talpur; Laila Tul Qadar

doi:10.7759/cureus.28968

Role of Serum Homocysteine and Outcome in Patients With Traumatic Brain Injury

Cureus. 2022 Sep 9;14(9):e28968. doi: 10.7759/cureus.28968. eCollection 2022 Sep.

Authors

Affiliations

¹ Cardiology, Liaquatian Academic and Research Society, Hyderabad, PAK.
² Cardiology, Sheikh Zayed Hospital and Medical College, Rahim Yar Khan, PAK.
³ Laparoscopic Surgery, Liaquatian Academic and Research Society, Hyderabad, PAK.
⁴ Internal Medicine, Liaquatian Academic and Research Society, Hyderabad, PAK.
⁵ Internal Medicine, Indus Medical College, Tando Muhammad Khan, PAK.
⁶ Anaesthesiology, Liaquatian Academic and Research Society, Hyderabad, PAK.
⁷ Internal Medicine, Marshfield Clinic Health System, Marshfield, USA.
⁸ Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK.
⁹ Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
¹⁰ Internal Medicine, Dow University of Health Sciences, Karachi, PAK.

Abstract

Background There have been indications of a correlation between serum homocysteine (Hcy) levels and poor patient outcomes in traumatic brain injury (TBI). Thus, we aimed to explore the role of serum Hcy in influencing the outcome post TBI. Methods A case-control study was conducted at Liaquat University of Medical and Health Sciences (LUMHS) between January 15, 2022 and July 1, 2022. All patients between the ages of 18 and 75 years who presented with TBI, irrespective of severity, were included in the study. All patients with neurological disorders and infections, including but not limited to cerebral tuberculosis, Alzheimer's disease, epilepsy, brain cancer, Parkinson's, and stroke, were excluded from the study. For comparison, healthy controls with similar demographics were enrolled in the study. All patients and controls underwent biochemical evaluation of serum Hcy and neurological assessment at presentation. In addition, all sociodemographic and clinical parameters, including the Glasgow Outcome Score (GOS), were collected in a predefined pro forma. Results A total of 175 patients were included who had experienced TBIs, along with an equal number of healthy controls. The most common etiology was road traffic accidents in 82 (46.9%) patients. The mean Glasgow Coma Score (GCS) at presentation was 5.78 ± 1.72. The mean Hcy levels were 31.4 ± 7.97 µmol/L in TBI patients and 11.12 ± 5.87 µmol/L in the control healthy patients (p=0.001). It was found that the severity of hyperhomocysteinemia (HHcy) was significantly related to the worst outcome possible, i.e., death (p=0.001). Conclusion The study concluded that patients who had suffered from a TBI had significantly higher serum Hcy levels. Furthermore, the study highlighted that the patients with the worst outcomes had more severe hyperhomocysteinemia (HHcy) than those with better outcomes. Moreover, patients with low GOS scores were more likely to have HHcy.

Keywords: glasgow outcome score; homocysteine levels; hyperhomocysteinemia; road traffic injuries; traumatic brain injury.