title: The effect of plasma homocysteine levels on clinical outcomes of patients with acute lung injury/acute respiratory distress syndrome.
abstract: 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.
authors.affiliation: Second Department of Critical Care Medicine, Attikon University General Hospital, Medical School, University of Athens, Athens, Greece. itsagkaris@med.uoa.gr
authors.forename: Iraklis
authors.initials: I
authors.lastname: Tsangaris
authors.forename: Argirios
authors.initials: A
authors.lastname: Tsantes
authors.forename: Pantelis
authors.initials: P
authors.lastname: Bagos
authors.forename: Georgios
authors.initials: G
authors.lastname: Nikolopoulos
authors.forename: Christos
authors.initials: C
authors.lastname: Kroupis
authors.forename: Petros
authors.initials: P
authors.lastname: Kopterides
authors.forename: Ioanna
authors.initials: I
authors.lastname: Dimopoulou
authors.forename: Stylianos
authors.initials: S
authors.lastname: Orfanos
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Kardoulaki
authors.forename: Stavros
authors.initials: S
authors.lastname: Chideriotis
authors.forename: Anthi
authors.initials: A
authors.lastname: Travlou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
mesh_terms: 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
chemical_list: D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; C051321:SERPINE1 protein, human; D006710:Homocysteine; D042965:Methylenetetrahydrofolate Reductase (NADPH2)