Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk

Abstract

Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index <97.5), admitted to medical and surgical departments. Results: Three hundred and ninety-six (28.8%) patients presented vitamin B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56–3.08; p < 0.001); it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15–41) versus 23 days (IQR 14–36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation.

Association of Plasma Concentration of Vitamin B12With All-Cause Mortality in the General Population in the Netherlands

“…1 While the deleterious effects of vitamin B 12 deficiency, such as anemia, neuropsychiatric symptoms, and other clinical manifestations, are well established, 2 the potential association of high plasma concentrations of vitamin B 12 with adverse health outcomes has not been fully explored. 3 Indeed, a potential association of high vitamin B 12 plasma concentrations with excess mortality has been assessed in elderly [3][4][5][6][7][8][9] and hospitalized 10,11 populations, but it has not been explored in the general population, to our knowledge.…”

Association of vitamin D and vitamin B12 with cognitive impairment in elderly aged 80 years or older: a cross‐sectional study

“…Capello et al . (2017) showed that elevated plasma vitamin B 12 concentrations (>1000 pg mL −1 ) had a significant association (>1000 pg mL −1 ) with mortality in hospitalised patients The risk of the in‐hospital mortality was 2.20 (range 1.56–3.08; P < 0.001), independent of age, gender and body mass index . Hemmersbach‐Miller et al .…”

“…Although we did not find data in the literature relating high levels of vitamin B 12 with cognitive damage, a high level of vitamin B associated with damage to health has been found. Capello et al (2017) showed that elevated plasma vitamin B 12 concentrations (>1000 pg mL À1 ) had a significant association (>1000 pg mL À1 ) with mortality in hospitalised patients The risk of the in-hospital mortality was 2.20 (range 1.56-3.08; P < 0.001), independent of age, gender and body mass index (39) . Hemmersbach- Miller et al (2005) reported the available vitamin B 12 levels for 366 patients: 187 nonagenarians and 179 controls aged 65-75 years.…”

Strength of the Association of Elevated Vitamin B12 and Solid Cancers: An Adjusted Case-Control Study

“…The group 'High-B12' included all the patients with a B12 ≥ 1000 ng/L. The threshold of 1000 ng/L corresponds to the normal upper limit of our assay, as in previous studies [4,[21][22][23]. The group 'Normal-B12' included patients who had B12 < 1000 ng/L and matched with patients of the High-B12 group according to sex, age, and the hospitalization department, at a 1:1 ratio.…”

“…Although its assay is mainly intended to detect deficiencies, incidental findings of elevated B12 levels are not uncommon [2]. In the absence of a consensus on the threshold that defines an abnormal increased B12 level, elevated B12 is generally defined as a level higher than the upper limit of the reference range, i.e., around 1000 +/− 100 ng/L (738 +/− 73.8 pmol/L) [2][3][4]. Abnormally elevated B12 has been attributed many causes [5,6], e.g., myeloid blood malignancies [7][8][9], acute or chronic liver diseases [10][11][12], chronic kidney failure, autoimmune or inflammatory diseases [3], and Gaucher disease [13].…”