ORIGINAL ARTICLE Independent impact of plasma homocysteine levels on neurological outcome following head injury Sivashanmugam Dhandapani 1 & Ankur Bajaj 1 & Chandrasekar Gendle 1 & Inderjeet Saini 2 & Irwanjeet Kaur 2 & Isha Chaudhary 2 & Jasandeep 2 & Jaspinder Kaur 2 & Geetanjali Kalyan 2 & Manju Dhandapani 2 & Sunil K. Gupta 1 Received: 1 June 2017 /Accepted: 5 July 2017 # Springer-Verlag GmbH Germany 2017 Abstract Homocysteine (tHcy) has been hardly studied among patients with head injury. This study was to evaluate whether there is any independent impact of tHcy levels on neurological outcome following head injury in a multivariate model. Patients admitted within 24 h of injury were included in the study, along with 20 age- and gender-matched controls. Plasma levels of tHcy were measured at admission using di- rect immunoassay. All the variables were analyzed with re- spect to tHcy levels and outcome according to Glasgow Outcome Score (GOS) at 3 months. Univariate and multivar- iate analyses were performed using SPSS 21. There were a total of 72 patients in the study. tHcy levels were significantly higher after head injury (mean 24.03[SD ± 16.0] μmol/L), compared to matched controls (mean 16.62 [SD ± 10.4] μmol/L) (p = 0.05). Patients with severe head injury, acute SDH, or diffuse higher radiological grades had greater levels of tHcy compared to others. There was a significant relation- ship between tHcy level and neurological outcome. tHcy levels were significantly higher in patients who had unfavor- able GOS (mean 36.22[±25.3] μmol/L), compared to those with favorable GOS (mean 22.71[±14.3] μ mol/L) (P = 0.03). In multivariate analysis, tHcy level (adj. odds ratio [OR] 1.17, P = 0.05) and Glasgow Coma Scale (adj. OR 5.17, P = 0.01) had significant association with neurological out- come at 3 months independent of age, dietary habit, radiolog- ical grading and of each other. tHcy level has significant in- dependent impact on neurological outcome and may be useful as a prognostic marker following head injury. Keywords Head injury . Homocysteine . Outcome . CT scan . Prognosis Introduction Head injury is one of the most common causes of mortality and morbidity in young people, causing immense socio- economic burden [1]. The imaging studies of brain are useful in therapeutic management, but have limited role in prognos- tication, as important pathophysiological events of secondary neuronal injury, such as cellular ischemia, oxidative stress and inflammatory response are not associated with visible radio- logical abnormalities [2–4]. The biochemical prognostic markers of these have also not been clearly established. Homocysteine (tHcy) is a sulfhydryl non-protein α-amino acid and branch-point intermediate of methionine metabolism [5, 6]. It has been used as a marker of oxidative stress leading to lipid peroxidation and reactive oxygen species. Higher levels of tHcy are associated with an increased risk of various neurovascular diseases such as stroke, Alzheimer disease, and subarachnoid hemorrhage. However, there are hardly two clinical studies of tHcy in head injury. While they showed some association with mortality, there was no clear indepen- dent association with neurological outcome after adjusting for all relevant prognostic factors [7, 8]. This study was conduct- ed to evaluate whether there is any independent impact of Sivashanmugam Dhandapani and Ankur Bajaj both to be considered first authors * Sivashanmugam Dhandapani ssdhandapani.neurosurg@gmail.com * Ankur Bajaj 1 Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India 2 NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-12, India Neurosurg Rev DOI 10.1007/s10143-017-0880-6