High prevalence of hyperhomocysteinemia in critically ill patients

Objective: To test the hypothesis that the prevalence of hyperhomocysteinem ia is increased in critically ill patients and correlates with disease seve rity and mortality in these patients. Design: A prospective study. Setting: Three medical intensive care units at the University of Vienna Med ical School serving both medical and surgical patients. Patients: All consecutive admissions (n = 56) during a period of 4 wks, A t otal of 112 age- and gender-matched healthy individuals constituted the con trol group. Interventions: None. Measurements and Main Results: Blood samples were drawn within 24 hrs after admission for analysis of total homocysteine (tHcy), folate, vitamin B-6 l evels, and vitamin B-12 levels as well as to identify the 677C-->T polymorp hism in the gene coding for the enzyme 5,10-methylenetetrahydrofolate reduc tase, Acute Physiology and Chronic Health Evaluation III scores at admissio n and 24 hrs after admission as well as 30-day survival were documented in all patients. Hyperhomocysteinemia was more prevalent in critically ill pat ients (16.1%; 95% confidence interval, 7.6% to 28.3%) compared with age- an d gender-matched healthy individuals (5.4%; 95% confidence interval, 2.0% t o 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 uni t between survivors and nonsurvivors, The 5,10-methylenetetrahydrofolate re ductase 677C-->T polymorphism had no influence on tHcy levels and survival of intensive care unit patients, Conclusions: The prevalence of hyperhomocysteinemia is increased in critica lly ill patients compared to age- and gender-matched healthy individuals, T he clinical significance of this finding remains to be determined.