Department of Intensive Care Unit, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China.
Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi, Hubei, China.
Horm Metab Res. 2022 Sep;54(9):593-603. doi: 10.1055/a-1897-5992. Epub 2022 Sep 7.
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.
高同型半胱氨酸血症（HHcy）在危重病患者中较为常见。然而，血清同型半胱氨酸水平与危重病患者结局之间的关系尚不清楚。我们对队列研究进行了荟萃分析，以全面评估上述相关性。通过检索电子数据库（包括 PubMed、Embase、Web of Science、万方和中国知网），从数据库建立到 2022 年 2 月 5 日，我们确定了相关的队列研究。采用包含可能的研究间异质性的随机效应模型来汇总结果。共有 16 项纳入 ICU 收治的 1663 例危重病患者的队列研究纳入荟萃分析。汇总结果显示，与危重病患者的非幸存者相比，幸存者在 ICU 入院时的血清 Hcy 水平显著降低[平均差值（MD）：-3.42μmol/L，95%置信区间（CI）：-5.89 至 0.94，p=0.007；I2=86%]。亚组分析显示，幸存者和非幸存者之间 Hcy 的差异在亚洲患者中具有统计学意义（MD：-8.17μmol/L，p<0.001），但在非亚洲患者中无统计学意义（MD：0.30μmol/L，p=0.62；p 值用于亚组差异<0.001）。此外，纳入了 7 项队列研究（均包含中国患者）的荟萃分析显示，ICU 入院时 HHcy 与危重病患者全因死亡率升高独立相关（比值比：2.99，95%CI：2.26 至 3.97，p<0.001；I2=69%）。ICU 入院时血清 Hcy 水平升高可能与危重病患者全因死亡率升高相关，尤其是在中国人群中。
