The effect of plasma homocysteine levels on clinical outcomes of patients with acute lung injury/acute respiratory distress syndrome.
BACKGROUND
Several reports have shown that homocysteine promotes thrombosis by disturbing the procoagulant-anticoagulant balance, whereas alterations in coagulation and fibrinolysis have been suggested as important pathogenetic and prognostic determinants of mortality in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). The objective of the study was to evaluate the effect of plasma homocysteine levels on the outcomes of patients with ALI/ARDS.


METHODS
Sixty-nine consecutive ventilated patients with ALI/ARDS were studied. Blood samples were drawn within 3 days of clinical recognition of ARDS. Measurement of plasma homocysteine, vitamin B12, folate, creatinine, protein C and plasminogen-activator inhibitor-1 antigen levels, and genotyping of the methylenetetrahydrofolate reductase gene C677T and A1298C polymorphisms were carried out. The primary outcomes were 28- and 90-day mortality, whereas secondary outcomes included nonpulmonary organ failure-free days, liberation from mechanical ventilation up to day 28, and ventilator-free days during the 28 days after enrollment.


RESULTS
In the multivariable analysis, plasma homocysteine concentration adjusted for age, Acute Physiology and Chronic Health Evaluation II score, methylenetetrahydrofolate reductase C677T and A1298C polymorphisms, and levels of plasminogen-activator inhibitor-1 antigen, protein C, creatinine, vitamin B12, and folate was not found to affect significantly mortality at 28 and 90 days (P = 0.39 and P = 0.83, respectively), days without organ failure besides lungs (P = 0.38), the probability of being free from mechanical ventilation at day 28 (P = 0.63), and days without ventilation assistance (P = 0.73).


CONCLUSIONS
Our data suggest that increased plasma homocysteine levels, either alone or in synergy with other thrombophilic risk factors, do not seem to adversely affect the prognosis in patients with ALI/ARDS.
Tsangaris
Iraklis
I
Second Department of Critical Care Medicine, Attikon University General Hospital, Medical School, University of Athens, Athens, Greece. itsagkaris@med.uoa.gr
Tsantes
Argirios
A
Bagos
Pantelis
P
Nikolopoulos
Georgios
G
Kroupis
Christos
C
Kopterides
Petros
P
Dimopoulou
Ioanna
I
Orfanos
Stylianos
S
Kardoulaki
Aikaterini
A
Chideriotis
Stavros
S
Travlou
Anthi
A
Armaganidis
Apostolos
A
D055371:Acute Lung Injury / Q000097:blood* / Q000201:enzymology / Q000235:genetics; D000368:Aged; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D020641:Polymorphism, Single Nucleotide; D011379:Prognosis; D011486:Protein C / Q000378:metabolism; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000201:enzymology / Q000235:genetics; D013997:Time Factors
D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; C051321:SERPINE1 protein, human; D006710:Homocysteine; D042965:Methylenetetrahydrofolate Reductase (NADPH2)