title: Pyridoxal-5'-phosphate deficiency is associated with hyperhomocysteinemia regardless of antioxidant, thiamine, riboflavin, cobalamine, and folate status in critically ill patients.
abstract: Critically ill patients develop severe stress, inflammation and a clinical state that may raise the utilization and metabolic replacement of pyridoxal-5'-phosphate decreasing their body reserves. This study was designed to assess the nutritional pyridoxal-5'-phosphate status in critical care patients with systemic inflammatory response syndrome, comparing them with a group of healthy people, and studying it's association with factors involved in the pyridoxine and other B vitamins metabolism, as the total antioxidant capacity and Hcy as cardiovascular risk biomarker.
  
  
  
  Prospective, multicentre, comparative, observational and analytic study. One hundred and three critically ill patients from different hospitals, and eighty four healthy subjects from Granada, Spain, all with informed consent. Data from daily nutritional assessment, ICU severity scores, clinical and nutritional parameters, antioxidant status and homocysteine levels was taken at admission and at the seventh day of the ICU stay.
  
  
  
  Thiamine, riboflavin, pyridoxine and folate status proved deficient in a large number of patients, being significantly lower in comparison with control group, and significantly decreased at 7th day of ICU stay. Higher homocysteine was observed in patients compared with control group (p < 0.05) where 31.5 and 26.8 percent of subjects presented hyperhomocysteinemia at initial and final of study, respectively. Antioxidant status was lower than control group in two periods analysed, and decreased at 7th day of ICU stay (p < 0.05) being associated with PLP deficiency. PLP deficiency was also correlated with hyperhomocysteinemia at two times measured (r. -0.73, p < 0.001; r. -0.69, p < 0.001, respectively), showing at day 7 an odds ratio of 6.62 in our multivariate model.
  
  
  
  Critically ill patients with SIRS show deficient B vitamin and low antioxidant statuses. Despite association found between PLP deficiency and low antioxidant status in critically ill patients, PLP deficiency was only associated with hyperhomocysteinemia regardless of antioxidant, riboflavin, cobalamine, and folate statuses in critically ill patients with SIRS at seventh day of ICU stay. PLP deficient patients presented about six times more risk of cardiovascular disease than non deficients.
authors.affiliation: Department of Physiology, Institute of Nutrition and Food Technology "José Mataix", University of Granada, Avda. del Conocimiento s/n, 18071 Granada, Spain. Electronic address: jrgmolinalopez@ugr.es.
authors.forename: Jorge
authors.initials: J
authors.lastname: Molina-López
authors.affiliation: Moorfields Hospital, University College Hospital, 162 City Road, London EC1V 2PD, UK. Electronic address: bio_dana@yahoo.com.
authors.forename: Daniela
authors.initials: D
authors.lastname: Florea
authors.affiliation: Department of Physical Chemistry, University of Granada, Campus de la Cartuja S/N, 18071 Granada, Spain. Electronic address: bqosso@ugr.es.
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Quintero-Osso
authors.affiliation: Nutrition & Dietetic Unit, Virgen de las Nieves Hospital, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain. Electronic address: antonioj.perez.sspa@juntadeandalucia.es.
authors.forename: Antonio Pérez
authors.initials: AP
authors.lastname: de la Cruz
authors.affiliation: Intensive Care Unit, Virgen de las Nieves Hospital, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain. Electronic address: manuel.rodriguez.elvira.sspa@juntadeandalucia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Elvira
authors.affiliation: Department of Physiology, Institute of Nutrition and Food Technology "José Mataix", University of Granada, Avda. del Conocimiento s/n, 18071 Granada, Spain. Electronic address: elenamp@ugr.es.
authors.forename: Elena Planells
authors.initials: EP
authors.lastname: Del Pozo
mesh_terms: D018806:APACHE; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D016638:Critical Illness; D005260:Female; D006710:Homocysteine / Q000097:blood / Q000378:metabolism; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D018384:Oxidative Stress; D015995:Prevalence; D011446:Prospective Studies; D011732:Pyridoxal Phosphate / Q000172:deficiency* / Q000378:metabolism; D012306:Risk; D013030:Spain / Q000453:epidemiology; D026681:Vitamin B 6 Deficiency / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000378:metabolism
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D011732:Pyridoxal Phosphate
keywords: Antioxidant capacity; B vitamins; Critical care patient; Homocysteine; Nutritional assessment; Pyridoxal-5′-phosphate