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ABSTRACT
Background and aims: Trimethylamine N-oxide (TMAO), a pro-atherosclerotic intestinal microbiota metabolite, has mechanistic links to atherosclerosis development and cardiovascular diseases. In this study, we aimed to investigate whether serum TMAO levels could predict early neurological deterioration (END) after acute ischemic stroke.
Methods: We prospectively recruited patients with first-ever ischemic stroke and hospitalized within 24 h of symptoms onset during Mar 2018 to Mar 2019. Plasma TMAO levels were quantified using stable isotope dilution high-performance liquid chromatography with tandem mass spectrometry after admission. END was defined as an increase in the total National Institutes of Health Stroke Scale by 2 or more points within 3 days.
Results: Of the 362 patients included, END was diagnosed in 97 subjects (26.8%). The median TMAO concentrations were 4.8 μmol/L, with tertile levels as follows: first tertile (<3.9 μmol/L), second tertile (3.9–5.6 μmol/L), and third tertile (>5.6 μmol/L). Patients with END showed higher levels of TMAO (median 5.0 vs. 4.5 μmol/L, P = 0.005) at admission. In univariate logistic analysis, elevated plasma levels of TMAO [odd ratios for highest tertile vs. lowest tertile, 2.14; 95% confidence interval, 1.19–3.82] was a significant predictor of END in patients with ischemic stroke. This association remained significant after controlling for confounders in multivariate logistic analysis. Multiple-adjusted spline regression model further confirmed the dose–response relationship between TMAO levels and END (P < 0.001 for linearity).
Conclusions: Our study indicated that increasing TMAO levels at admission might be associated with END after acute ischemic stroke.
Data availability statement
The data that support the findings of this study are available on request from the corresponding author.
Disclosure statement
All the authors declare that there is no conflict of interest.
Notes
Abbreviations: Hs-CRP, Hyper-sensitive C-reactive protein; NIHSS, National Institutes of Health Stroke Scale; TMAO, Trimethylamine N-Oxide.
Abbreviations: Hs-CRP, Hyper-sensitive C-reactive protein; NIHSS, National Institutes of Health Stroke Scale; TMAO, Trimethylamine N-Oxide.
Additional information
Notes on contributors
Le Hou
Le Hou is a neurologist in Guangzhou Huiai Hospital. His research and scholarship have mainly focused on ischemic stroke. In addition to these Zhang has published articles in leading journals. Her aim with this article is to share personal experiences and make a contribution to the development of Neurology.
Yun Zhang
Yun Zhang is a neurologist in Mianyang Hospital. Her research and scholarship have mainly focused on cerebrovascular disease. In addition to these Zhang has published articles in leading journals. Her aim with this article is to share personal experiences and make a contribution to the development of Neurology.
Dong Zheng
Dong Zheng is a neurologist in Guangzhou Huiai Hospital. His research and scholarship have mainly focused on ischemic stroke. In addition to these Zhang has published articles in leading journals.
Haishan Shi
Haishan Shi is a neurologist in Guangzhou Huiai Hospital. Her research and scholarship have mainly focused on neurology.
Cong Zou
Cong Zou is a neurologist in Guangzhou Huiai Hospital. Her research and scholarship have mainly focused on neurology.
Hui Zhang
Hui Zhang is a neurologist in Guangzhou Huiai Hospital. Her research and scholarship have mainly focused on neurology.
Zhiwei Lu
Zhiwei Lu is a neurologist in Guangzhou Huiai Hospital. His research and scholarship have mainly focused on cerebrovascular disease. In addition to these Zhang has published articles in leading journals.
Hongcai Du
Hongcai Du a neurologist in Mianyang Hospital. His research and scholarship have mainly focused on cerebrovascular disease.