Increased Vitamin B12 levels are associated with mortality in critically ill medical patients

Sviri, Sigal; Khalaila, Rabia; Daher, Saleh; Bayya, Abed; Linton, David M.; Stav, Ilana; Heerden, Peter Vernon van

doi:10.1016/j.clnu.2011.08.010

Cited by 61 publications

(64 citation statements)

References 31 publications

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“…Thus, the indicators of PEW including serum albumin may have a large bearing on the link between folate, Hcy, cardiovascular events and death in this population. Also, B12's link with mortality and its impact on the folate-mortality relationship may be because high serum B12 is not evidence of higher intake or lower excretion, but it is an indicator of significant inflammation and PEW [18,20]. This hypothesis is also supported by prior observations of an association between serum B12 and two indicators of inflammation: C-reactive protein and ferritin.…”

Section: Discussionsupporting

confidence: 73%

“…This mechanism may be an evolutionary adaptation to deter B12 away from pathogenic organisms causing inflammation and infection in peripheral tissues. Thus, in inflammatory conditions such as HD, higher circulating concentrations of serum B12 may actually indicate functional B12 deficiency in the peripheral tissues that may eventually lead to hyperhomocysteinemia, cardiovascular sequelae and death [20]. Notably, the B12-mortality association was slightly attenuated after adjusting for case-mix and MICS covariates when examined as a continuous variable (Supplementary data, Figure S1).…”

Section: Discussionmentioning

confidence: 88%

“…predisposition to inflammation, such as the HD population [16,17], decreased production of transcobalamin II may lead to reduced uptake of circulating B12 by peripheral tissues, and heightened synthesis of transcobalamins I and III further augment accumulation of B12 in serum [18][19][20]. This mechanism may be an evolutionary adaptation to deter B12 away from pathogenic organisms causing inflammation and infection in peripheral tissues.…”

Section: Discussionmentioning

confidence: 99%

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Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients

Soohoo

Ahmadi

Qader

et al. 2016

Nephrology Dialysis Transplantation

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A B S T R A C TBackground: Vitamin B12 (B12) and folate are essential vitamins that play important roles in physiological processes. In the general population, many studies have evaluated the association of these vitamins with clinical outcomes, yet this association in hemodialysis (HD) patients remains unclear. Methods: We examined the association of serum folate and B12 with mortality in a 5-year cohort of 9517 (folate) and 12 968 (B12) HD patients using Cox models with hierarchical adjustment for sociodemographics, comorbidities, and laboratory variables associated with the malnutrition and inflammation complex syndrome. The associations of baseline B12 and folate (separately) with all-cause mortality were evaluated across five categories of B12 [<400 (reference), 400-<550, 550-<650, 650-<750 and !750 pg/mL] and folate [<6.2, 6.2-<8.4, 8.4-<11 (reference), 11-<14.3 and !14.3 ng/mL]. Results: The study cohort with B12 measurements had a mean 6 standard deviation age of 63 6 15 years, among whom 43% were female, 33% were African-American, and 57% were diabetic. Higher B12 concentrations !550 pg/mL were associated with a higher risk of mortality after adjusting for sociodemographic and laboratory variables. However, only lower serum folate concentrations <6.2 ng/mL were associated with a higher risk of all-cause mortality when adjusted for sociodemographic variables [adjusted hazard ratio (95% confidence-interval): 1.18 (1.03-1.35)]. Conclusions: Higher B12 concentrations are associated with higher all-cause mortality in HD patients independent of sociodemographics and laboratory variables, whereas lower folate concentrations were associated with higher all-cause mortality after accounting for sociodemographic variables. Further studies are warranted to determine the optimal B12 and folate level targets in this population.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients

Soohoo

Ahmadi

Qader

et al. 2016

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

show abstract

“…30 Over the past decade, there has been signifi cant interest in the use of cobalamin as a marker of mortality, as studies have demonstrated an association between high vitamin B 12 levels and mortality in hospitalised older patients, 29 as well as in those admitted to intensive care. 31 Once again, these are preliminary fi ndings which need validation in good trials before widespread acceptance.…”

Section: Are High Serum Vitamin B 12 Levels Signifi Cant?mentioning

confidence: 99%

Vitamin B12 deficiency – A 21st century perspective

2015

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“…One recent observational study indicated an increased mortality rate in patients with Vitamin B 12 levels over 900 pg/ml (p-value < 0.0002). 119 Nutrition therapy practitioners should always bear in mind that "much more is not necessarily better" and that some micronutrients have or may have a narrow therapeutic window when high-dose supplementation is being considered. Furthermore, in this group of patients the potential exists for the creation of a prooxidant microenvironment with deleterious patient outcomes.…”

Section: Cccpg Aspen/sccm Espenmentioning

confidence: 99%