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Higher plasma homocysteine is associated with lower vitamin B‐6 in critically ill surgical patients

Stress, inflammation and clinical conditions may increase the utilization and metabolic turnover of B‐vitamins (i.e., folate, vitamin B‐6 and B‐12). Hyperhomocysteinemia might be at least partially due to compromised B‐vitamin status in critically ill patients. This cross‐sectional study was to examine the association of plasma homocysteine with B‐vitamins in critically ill surgical patients. Thirty‐four patients in the surgical intensive care unit were enrolled. Disease severity (APACHE II score), albumin, C‐reactive protein (CRP), serum folate and vitamin B‐12, plasma and erythrocyte pyridoxal 5′‐phosphate (PLP) were determined within 24 h of admission and again after 7 days. Plasma homocysteine, serum folate and vitamin B‐12 concentrations significantly increased by day 7, whereas plasma and erythrocyte PLP remained constant throughout the study. Plasma homocysteine was not correlated with serum folate and vitamin B‐12. However, plasma PLP concentration at admission had a significant effect on the 1st day (β= −0.06, p < 0.05) and 7th day (β= −0.05, p < 0.05) of plasma homocysteine after adjusting for age, gender, APACHE II score and CRP levels. Lower plasma PLP might be a major contributing factor in the increase of plasma homocysteine concentration in critically ill surgical patients. This study was supported by Changhua Christian Hospital and Chung Shan Medical University (97‐CCH‐CSMU‐07), Taiwan.