High prevalence of hyperhomocysteinemia in critically ill patients: Vascular damage and adequate vitamin intake

SummaryAimsTo determine the prevalence of hyperhomocysteinaemia in critically ill patients and its relationship with endothelial damage and vitamin intake.MethodsTotal antioxidant capacity, lipid peroxides, and carbonyl group in plasma were measured by spectrophotometry. Homocysteine, D-dimer, B12 vitamin and folic acid levels were determined by immunoassay. Daily diet records were compared with vitamin recommendations in 40 consecutive critically ill patients.ResultsHomocysteinaemia on day 7 was higher in patients with <90% of recommended intake vitamin B12 and folic acid than in patients with higher intakes (16.3 ± 3.1 μm/L vs. 9.3 ± 54 μm/L, p < 0.05). An adequate supply of B12 vitamin and folic acid reduces the risk of hyperhomocysteinaemia (OR 0.43; 95% CI 0.01–0.08). Significant correlations were found between homocysteine, lipid peroxides (r2 = 0.65, p < 0.001) and carbonyl group (r2 = 0.58, p < 0.001). Antioxidant capacity showed a significant association with homocysteine (r2 = −0.57, p < 0.001). A significant correlation was found between D-dimer and homocysteinaemia (r2 = 0.47, p < 0.001).ConclusionsThe present findings appear to support the maintenance of an adequate vitamin intake in critically ill patients to reduce their risk of hyperhomocysteinemia, and therefore microthromboses. However, controlled clinical trials are required to establish any causal relationships.