[Prognostic value of serum homocysteine levels in elderly hospitalized patients].

BACKGROUND AND OBJECTIVES: Increased serum homocysteine levels are related to vascular disease and increased mortality. The decrease of homocysteine is also associated with a worse prognosis in patients on hemodialysis; however, this relationship has not been well studied in other patients. Our goal is to study the prognosis of increased and decreased serum homocysteine levels in elderly patients admitted to a general internal medicine unit. PATIENTS AND METHODS: We included 239 patients (121 women and 118 men; mean age, 78 years) in which we determined serum homocysteine levels and study its relationship with vascular risk factors, vascular disease: ischemic heart disease, ischemic stroke and peripheral arterial disease, nutritional status, creatinine, albumin, folate and B12 vitamin. RESULTS: Mortality during hospitalization of patients with homocysteine levels below 9 μmol/l was 33%, 9% for those with levels between 9 and 20 μmol/l and 17% for those with levels above 20 μmol/l. Low homocysteine values were related to increased comorbidity, higher degree of weight loss and decreased serum albumin levels. In a survival analysis using Kaplan-Meier curves, increased homocysteine was associated with increased mortality especially in patients with vascular disease. CONCLUSION: In elderly patients with multiple comorbidities, both decreased and increased serum homocysteine levels are associated with increased mortality.