Total homocysteine plasmatic levels as a marker of clinical severity in septic patients

Introduction

Homocysteine (Hcy) is a sulfur-containing amino acid formed during methionine metabolism that has been appointed as a marker of cardiovascular disease. The mechanisms involved are unclear, but include an increase in oxidative stress, excessive thrombogenesis, mitotic alterations in smooth muscular cells and endothelial dysfunction. Some of these mechanisms are present in septic patients, suggesting that total homocysteine (tHcy) levels might be implicated in the pathogenesis of organ dysfunction. The objective of this study is to correlate tHcy levels and the severity of septic process, evaluated by the SOFA score.

Methods

In this prospective clinical trial, patients admitted to a tertiary university ICU with severe sepsis were included, before 48 hours of organ dysfunction diagnosis. Patients with acute renal failure were excluded. Blood samples were collected after 8 hours of starvation, together with SOFA parameters, on days 1, 3, 7 and 14 after inclusion. Statistical analysis was performed using the Spearman correlation ratio relating SOFA and Hcy during each moment of evaluation.

Results

We studied 60 samples of tHcy in 21 patients (10 female and 11 male), mean age 44.05 ± 19.42 years with a mean APACHE score of 22 (minimum 2, maximum 35). The mean tHcy values for each day studied were 9.479 ± 6.520 μmol/l (n = 21), 8.025 ± 4.592 μmol/l (n = 19), 8.637 ± 4.620 μmol/l (n = 15), 6.897 ± 3.704 μmol/l (n = 5), and mean SOFA scores were 7.62 ± 3.72 (n = 21), 5.63 ± 3.05 (n = 19), 4.6 ± 2.5 (n = 15), 2.8 ± 1.92 (n = 5), respectively, for days 1, 3, 7 and 14.

Conclusion

Our results suggest that Hcy levels could not be related to organ dysfunction, measured through the SOFA score, in this septic patient population.