Hyperhomocysteinaemia as an indicator of infection and disease severity in ICU patients

Objective

The goal of this study was to evaluate the correlation of homocystein (HCY) with a severity score and other hematological and biochemical parameters in critically ill patients treated in a multidisciplinary ICU.

Materials and methods

After ethical committee approval, 31 ICU patients were enrolled in this prospective study. They had mean age 56.33 ± 15.8 and APACHE score 28.5 ± 3.11 at the time of admission in the ICU. The 13/31 patients were admitted after surgical procedures while the others 18/31 on account of medical reasons. The following parameters were recorded: HCY, folic acid, WBC, PT, PTT, PLTs, fibrinogen, temperature and CRP. They were all documented in all patients at admission time and every 2 days for 2 weeks. The statistical analysis was performed with Pearson's correlation test. The level of correlating significance was assumed if r < 0.05.

Results

At admission time, we observed a significant correlation between HCY and APACHE II score (r < 0.01). At the same time, the parameters temperature, WBC, CRP, folic acid, and PTT were significantly correlated to HCY (r < 0.01, r < 0.01, r < 0.01, r < 0.01, r < 0.05, respectively). The next 4 days after admission the correlation between the parameters mentioned above remains strong but the correlating level of the significance was lower (r < 0.05, for all parameters). After the 6th day until the end of the study, the correlation was changed and remained steady for folic acid, WBC and CRP (r < 0.05 for each of them). The mean duration of ICU stay was 17.13 ± 3.14 days.

Conclusions

Hcy is an amino acid, which seems to be correlated with disease severity (APACHE score) and also strongly correlated with infections factor as temperature, WBC, CRP. This lets us accept HCY as an evaluation factor of inflammatory conditions in ICU patients.