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High prevalence of hyperhomocysteinemia in critically ill patients

Schindler, Karin MSc; Zauner, Christian MD; Buchmayer, Heidi PhD; Födinger, Manuela MD; Wölfl, Gabriele MSc; Bieglmayer, Christian PhD; Heinz, Gottfried MD; Wilfing, Astrid MD; Hörl, Walter H. MD, PhD, FRCP; Sunder-Plassmann, Gere MD

Clinical Investigations

Objective: To test the hypothesis that the prevalence of hyperhomocysteinemia is increased in critically ill patients and correlates with disease severity and mortality in these patients.

Design: A prospective study.

Setting: Three medical intensive care units at the University of Vienna Medical School serving both medical and surgical patients.

Patients: All consecutive admissions (n = 56) during a period of 4 wks. A total of 112 age- and gender-matched healthy individuals constituted the control group.

Interventions: None.

Measurements and Main Results: Blood samples were drawn within 24 hrs after admission for analysis of total homocysteine (tHcy), folate, vitamin B6 levels, and vitamin B12 levels as well as to identify the 677C→T polymorphism in the gene coding for the enzyme 5, 10-methylenetetrahydrofolate reductase. Acute Physiology and Chronic Health Evaluation III scores at admission and 24 hrs after admission as well as 30-day survival were documented in all patients. Hyperhomocysteinemia was more prevalent in critically ill patients (16.1%; 95% confidence interval, 7.6% to 28.3%) compared with age- and gender-matched healthy individuals (5.4%; 95% confidence interval, 2.0% to 11.3%; chi-square test; p = .022). There was no difference in tHcy plasma concentrations in the first 24 hrs after admission to an intensive care unit between survivors and nonsurvivors. The 5,10-methylenetetrahydrofolate reductase 677C→T polymorphism had no influence on tHcy levels and survival of intensive care unit patients.

Conclusions: The prevalence of hyperhomocysteinemia is increased in critically ill patients compared to age- and gender-matched healthy individuals. The clinical significance of this finding remains to be determined.

From the Universitätsklinik für Innere Medizin III (Ms. Schindler, Drs. Hörl and Sunder-Plassmann); Universitäts klinik für Innere Medizin IV (Dr. Zauner); Klinisches Institut für Medizinische und Chemische Labordiagnostik (Drs. Buchmayer, Födinger, and Bieglmayer); Institut für Medizinische Statistik (Ms. Wölfl); Universitätsklinik für Innere Medizin II (Dr. Heinz); and Universitätsklinik für Innere Medizin I (Dr. Wilfing), Universität Wien, Vienna, Austria.

Address requests for reprints to: Gere Sunder-Plassmann, MD, Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, A-1090 Wien, Austria.

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