The association of plasma homocysteine levels with short-term mortality in sepsis patients: A meta-analysis

TL;DR

This study found that plasma homocysteine levels are not generally linked to short-term mortality in sepsis patients, but a connection was observed in Chinese patients.

Contribution

The study identifies potential ethnic differences in the association between homocysteine levels and sepsis mortality.

Findings

Overall, no significant difference in homocysteine levels was found between sepsis survivors and non-survivors.

Chinese sepsis patients showed lower homocysteine levels in survivors compared to non-survivors.

A significant association between higher homocysteine levels and increased mortality was found in Chinese patients.

Abstract

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: 0.95–1.11, P ═ 0.51), with notable heterogeneity (I2 ═ 72%). However, a significant association was found in Chinese patients (OR: 1.09, 95% CI: 1.03–1.15, 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.

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