Nível plasmático de homocisteína: marcador de gravidade em pacientes sépticos?

Neto, Antonio Coelho; Azevedo, Rodrigo Palácio de; Santos, Maria Bethania Peruzzo; Galdieri, Luciano de Camargo; D’Almeida, Vânia; Amaral, José Luiz Gomes do; Freitas, Flávio Geraldo Resende; Machado, Flávia Ribeiro

doi:10.1590/s0103-507x2010000400003

Cited by 3 publications

(6 citation statements)

References 29 publications

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“…4. Basal homocysteine levels have been found to not be associated with the severity and mortality of septic patients [15]. In a study by Tsantes et al [16], basal homocysteine levels in sepsis patients were observed to be within normal levels.…”

Section: Discussionmentioning

confidence: 99%

Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock

et al. 2019

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Aim The aim of this study was to evaluate oxidative stress from glutathione depletion in critically ill patients with a septic shock through the abnormal presence of pyroglutamic acid (PyroGlu) in the urine (indirectly) and through its serum level (directly). Methods This was a prospective analytical study of 28 critically ill patients with a septic shock who were monitored from admission (initial) to 3 days of stay (final) in the intensive care unit (ICU). Data collected included PyroGlu and glutamic acid (Glu) using liquid chromatography/mass spectrometry, and glutathione peroxidase (GPX) activity with a colorimetric assay. The differences in Glu, PyroGlu, and GPX activity between the septic shock group and healthy control group serving as reference values were evaluated using the Mann–Whitney test. The correlations between Glu, PyroGlu, and GPX activity and clinical outcomes were determined using Spearman’s correlation coefficient. Results In patients with septic shock, serum and urine PyroGlu levels were higher, erythrocyte GPX activity/gr Hb was lower, and urine Glu levels were lower compared to healthy control reference values, for both initial and final values. Initial serum Glu levels were also lower. Serum PyroGlu levels had a correlation with both initial and final serum Glu levels; levels also correlated in the urine. Initial serum Glu correlated with the days of mechanical ventilation ( P = 0.016) and the days of ICU stay ( P = 0.05). Urine Glu/mg creatinine correlated with APACHE II ( P = 0.030). This positive correlation observed for serum Glu was not observed for PyroGlu. Conclusions The current study found that septic patients have higher levels of PyroGlu, lower levels of Glu, and lower erythrocyte GPX activity, suggesting that these biomarkers could be used as an indicator of glutathione depletion. In addition, Glu is related to severity parameters. This study can guide future studies on the importance of monitoring the levels of pyroglutamic acidosis in critical patients with septic shock in order to preserve the oxidative status and its evolution during the stay in the ICU.

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Section: Discussionmentioning

confidence: 99%

Pyroglutamic acidosis by glutathione regeneration blockage in critical patients with septic shock

et al. 2019

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“…1 . Finally, 16 cohort studies 17 18 19 20 21 22 23 24 25 26 34 35 36 37 38 39 were available for the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Table 1 , 16 cohort studies were included in the meta-analysis. Six of them were prospective cohort studies 17 19 21 34 36 39 and the remaining were retrospective cohort studies 18 20 22 23 24 25 26 35 37 38 . These studies were performed in Austria 17 18 20 , Greece 21 , Brazil 19 , the United States 35 36 , Iran 34 , and China 22 23 24 25 26 37 38 39 , and all included critically ill patients who were admitted to the ICU, such as patients with sepsis, pulmonary embolism, acute myocardial infarction, severe acute pancreatitis, respiratory failure, intracerebral hemorrhage, and severe multiple trauma etc.. Serum Hcy was measured within 48 hours of ICU admission, and the follow-up durations varied from 2 weeks to 12 months.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 375 patients died during follow-up. Difference of serum Hcy at ICU admission between survivors and non-survivors was reported in 13 studies 17 18 19 20 21 24 25 26 34 35 36 37 39 with 985 patients, while the association between HHcy and all-cause mortality of the critically ill patients was reported in 7 studies 22 23 24 25 26 37 38 with 1013 patients. For the latter studies, HHcy was all defined as serum Hcy>15 μmol/l, and the association between HHcy and all-cause mortality was analyzed with multivariate models incorporating age, sex, and other parameters of disease severity.…”

Section: Resultsmentioning

confidence: 99%

“…However, the potential prognostic significance of serum Hcy on clinical outcomes of patients with critical illnesses remains unclear. Some early studies failed to show that the serum level of Hcy was different between survivors and non-survivors of the critically ill patients 17 18 19 20 21 , while other studies showed that HHcy at baseline may be a risk factor of increased mortality in these patients 22 23 24 25 26 . Therefore, we performed a systematic review and meta-analysis to comprehensively evaluate the potential association between serum Hcy and outcomes of the critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Homocysteine and the Mortality of Critically Ill Patients: A Meta-Analysis

Yuan

Zheng

2022

Horm Metab Res

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Prevalence of hyperhomocysteinemia (HHcy) is high in critically ill patients. However, the association between serum homocysteine level and outcomes of the critically ill patients remains unknown. We performed a meta-analysis of cohort studies to comprehensively evaluate the above association. Relevant cohort studies were identified by search of electronic databases including PubMed, Embase, Web of Science, Wanfang, and CNKI from the inception of the databases to February 5, 2022. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. Overall, 16 cohorts with 1663 critically ill patients who were admitted to the intensive care unit (ICU) were involved in the meta-analysis. Pooled results showed that compared to non-survivors of the critical illnesses, survivors had significantly lower serum level of Hcy at ICU admission [mean difference (MD): –3.42 μmol/l, 95% confidence interval (CI): –5.89 to 0.94, p=0.007; I2=86%]. Subgroup analysis showed that the difference of Hcy between survivors and non-survivors was significant in Asian patients (MD: –8.17 μmol/l, p<0.001), but not in non-Asians (MD: 0.30 μmol/l, p=0.62; p for subgroup difference<0.001). Moreover, meta-analysis with seven cohorts, all including Chinese patients, showed that HHcy at ICU admission was independently associated with a higher risk of all-cause mortality in critically ill patients (odds ratio: 2.99, 95% CI: 2.26 to 3.97, p<0.001; I2=69%). A higher serum level of Hcy at ICU admission may be associated with an increased risk of all-cause mortality in critically ill patients, particularly in the Chinese population.

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