title: Homocysteine plasma levels as a marker of clinical severity in septic patients.
abstract: OBJECTIVE
  Homocysteine and sepsis are both associated with inflammation and endothelial activation. Therefore this study was aimed to evaluate if the plasma homocystein level is related with the septic patient clinical severity.
  
  
  METHODS
  Severe sepsis or septic shock patients, with less than 48 hours from organ dysfunction start, were admitted to this prospective observational study. Homocysteine levels were determined by the time of study admission and then on the Days 3, 7 and 14. The homocysteine association with the Sequential Organ Failure Assessment (SOFA) score was evaluated using the Sperman test, and its association with mortality using the Mann-Whitney test. A p<0.05 value was considered statistically significant.
  
  
  RESULTS
  Twenty one patients were enrolled, and 60 blood samples were collected to measure total homocysteine [median 6.92 (5.27 - 9.74 μmol/L)]. The Sperman correlation test showed no association between homocysteine and SOFA ( r=0.15 and p=0.26). Also no correlation was found for the homocysteine level by the study admission time and the difference between the Day 3 SOFA score versus by study admission (deltaSOFA) (r=0.04 and p=0.87). Homocysteine variation between the Day 3 and the study admission (deltaHmc) and SOFA score variation in the same period were not correlated (r=-0.11 and p=0.66). Homocysteine by the study admission was not correlated with death in intensive care unit rate (p= 0.46) or in-hospital death rate (p = 0.13). This was also true for deltaHmc (p=0.12 and p=0.99, respectively).
  
  
  CONCLUSIONS
  Baseline homocysteine levels and its variations within the first dysfunction days were not related with septic patients' worsened organ function parameters or mortality.
authors.affiliation: Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Coelho Neto
authors.affiliation: Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Rodrigo Palácio
authors.initials: RP
authors.lastname: Azevedo
authors.affiliation: Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Maria Bethania Peruzzo
authors.initials: MB
authors.lastname: Santos
authors.forename: Luciano de Camargo
authors.initials: Lde C
authors.lastname: Galdieri
authors.forename: Vânia
authors.initials: V
authors.lastname: D'Almeida
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Jose Luiz Gomes do
authors.initials: JL
authors.lastname: Amaral
authors.affiliation: Setor de Terapia Intensiva da Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Flávio Geraldo Resende
authors.initials: FG
authors.lastname: Freitas
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Flavia Ribeiro
authors.initials: FR
authors.lastname: Machado