Lu Xinxing, Yuan Xueyan, Chao Yali, Wu Xiao, Liu Airan
Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.
Biomol Biomed. 2025 Mar 7;25(4):786-797. doi: 10.17305/bb.2024.11259.
The association between plasma homocysteine (Hcy) levels and short-term mortality in sepsis patients remains unclear. This meta-analysis aimed to clarify this potential relationship. Following PRISMA 2020 and Cochrane Handbook guidelines, we conducted a comprehensive literature search in the PubMed, Embase, and Web of Science databases up to June 24, 2024. We included cohort studies that assessed the association between plasma Hcy levels and all-cause mortality in adult sepsis patients. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model to account for potential heterogeneity. Nine cohort studies involving 771 sepsis patients were included. Overall, no significant difference in plasma Hcy levels was observed between survivors and non-survivors (SMD: -0.23, 95% CI: -0.84 to 0.37, P = 0.45), with substantial heterogeneity (I² = 86%). Subgroup analysis revealed lower plasma Hcy levels among survivors in Chinese patients (SMD: -1.56, 95% CI: -1.98 to -1.13, P < 0.001) but not in non-Asian patients. Plasma Hcy levels were not significantly associated with all-cause mortality (OR per 1-unit increment: 1.03, 95% CI: 0.95 to 1.11, P = 0.51), with notable heterogeneity (I² = 72%). However, a significant association was found in Chinese patients (OR: 1.09, 95% CI: 1.03 to 1.15, P = 0.003), but not in non-Asian patients. In conclusion, plasma Hcy levels were not generally associated with short-term mortality in sepsis patients. However, significant associations were observed in Chinese patients, suggesting potential ethnic differences that warrant further investigation.
脓毒症患者血浆同型半胱氨酸（Hcy）水平与短期死亡率之间的关联尚不清楚。本荟萃分析旨在阐明这种潜在关系。按照PRISMA 2020和Cochrane手册指南，我们在截至2024年6月24日的PubMed、Embase和Web of Science数据库中进行了全面的文献检索。我们纳入了评估成年脓毒症患者血浆Hcy水平与全因死亡率之间关联的队列研究。使用随机效应模型计算标准化均数差（SMD）和比值比（OR）以及95%置信区间（CI），以考虑潜在的异质性。纳入了9项涉及771例脓毒症患者的队列研究。总体而言，幸存者和非幸存者之间血浆Hcy水平未观察到显著差异（SMD：-0.23，95%CI：-0.84至0.37，P = 0.45），存在显著异质性（I² = 86%）。亚组分析显示，中国患者的幸存者血浆Hcy水平较低（SMD：-1.56，95%CI：-1.98至-1.13，P < 0.001），而非亚洲患者则不然。血浆Hcy水平与全因死亡率无显著关联（每增加1个单位的OR：1.03，95%CI：0.95至1.11，P = 0.51），存在显著异质性（I² = 72%）。然而，在中国患者中发现了显著关联（OR：1.09，95%CI：1.03至1.15，P = 0.003），而非亚洲患者则未发现。总之，脓毒症患者血浆Hcy水平一般与短期死亡率无关。然而，在中国患者中观察到了显著关联，提示可能存在种族差异，值得进一步研究。
