Prognostic value of serum homocysteine levels in elderly hospitalized patients

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. 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. 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. In elderly patients with multiple comorbidities, both decreased and increased serum homocysteine levels are associated with increased mortality.