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Background: Hyperhomocysteinemia might be at least partially due to compromised B vitamin status in critically ill patients and has been linked with critical illness. This study was conducted to examine the association between plasma homocysteine with B vitamins and clinical outcomes in critically ill surgical patients.

Methods: Thirty-two patients in the surgical intensive care unit (SICU) were enrolled. Disease severity (Acute Physiology and Chronic Health Evaluation II score), hematological values, serum and erythrocyte folate, serum vitamin B12, plasma, and erythrocyte pyridoxal 5'-phosphate (PLP) were determined within 24 hours of admission and again after 7 days.

Results: The prevalence of hyperhomocysteinemia in the patients was either 46.9% (plasma homocysteine >=12 [mu]mol/L) or 31.3% (plasma homocysteine >=15 [mu]mol/L) on day 1 in the SICU and increased to 62.5% (plasma homocysteine >=12 [mu]mol/L) and 37.5% (plasma homocysteine >=15 [mu]mol/L) on day 7 after admission to the SICU. Plasma homocysteine, serum folate, and vitamin B12 significantly increased by day 7, whereas plasma and erythrocyte PLP remained constant throughout the study. Plasma homocysteine was not correlated with serum folate and vitamin B12. However, plasma and erythrocyte PLP on day 1 were adversely associated with day 1 levels of plasma homocysteine after adjusting for potential confounders. Plasma homocysteine on day 1 or changes ([DELTA] day 7 - day 1) did not show any association with clinical outcomes.

Conclusions: Lower plasma PLP might be a significant factor for increased plasma homocysteine in critically ill surgical patients. The association between plasma homocysteine and clinical outcomes was not found. (Nutr Clin Pract. 2012;27:695-700)

(C)2012Sage Publications