Fiona M Callaghan1, Kira Leishear2, Swapna Abhyankar3, Dina Demner-Fushman3, Clement J McDonald3. 1. (Co-first author) Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Building 38A/9N911, Bethesda, MD 20894, USA, 301-435-3199 (phone) 301 496 0673 (fax). 2. (Co-first author) Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Boulevard, Rockville, MD 20892, USA. 3. Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA.
Abstract
BACKGROUND AND AIMS: Recent research has suggested that high vitamin B12 levels may be associated with increased mortality after ICU admission. However, it is known that impaired liver function may lead to elevated B12 since B12 is metabolized through the liver, and therefore high B12 levels may serve as a proxy for poor liver function. The aim of this study is to assess the impact that liver function and liver disease have on the relationship between high vitamin B12 levels and mortality in the ICU. METHODS: We performed an observational cohort study using ICU data that were collected from patients admitted to four ICU types (medical, surgical, cardiac care and cardiac surgery recovery) in one large urban hospital from 2001 to 2008. We analyzed the medical records of 1,684 adult patients (age ≥ 18 years) who had vitamin B12 and liver function measurements up to 14 days prior to ICU admission or within 24 hours after admission. RESULTS: While we found an association between high B12 and mortality when we did not control for any potential confounders, after we adjusted for liver function and liver disease, no significant association existed between B12 and mortality using multivariable logistic regression (30-day mortality: OR=1.18, 95% CI 0.81 to 1.72, p=0.3890; 90-day mortality: OR=1.20, 95% CI 0.84 to 1.71, p=0.3077). CONCLUSIONS: Elevated B12 levels are not a significant predictor of mortality after ICU admission when liver function is controlled for, and may instead be a proxy for poor liver function.
BACKGROUND AND AIMS: Recent research has suggested that high vitamin B12 levels may be associated with increased mortality after ICU admission. However, it is known that impaired liver function may lead to elevated B12 since B12 is metabolized through the liver, and therefore high B12 levels may serve as a proxy for poor liver function. The aim of this study is to assess the impact that liver function and liver disease have on the relationship between high vitamin B12 levels and mortality in the ICU. METHODS: We performed an observational cohort study using ICU data that were collected from patients admitted to four ICU types (medical, surgical, cardiac care and cardiac surgery recovery) in one large urban hospital from 2001 to 2008. We analyzed the medical records of 1,684 adult patients (age ≥ 18 years) who had vitamin B12 and liver function measurements up to 14 days prior to ICU admission or within 24 hours after admission. RESULTS: While we found an association between high B12 and mortality when we did not control for any potential confounders, after we adjusted for liver function and liver disease, no significant association existed between B12 and mortality using multivariable logistic regression (30-day mortality: OR=1.18, 95% CI 0.81 to 1.72, p=0.3890; 90-day mortality: OR=1.20, 95% CI 0.84 to 1.71, p=0.3077). CONCLUSIONS: Elevated B12 levels are not a significant predictor of mortality after ICU admission when liver function is controlled for, and may instead be a proxy for poor liver function.
Authors: P S Kamath; R H Wiesner; M Malinchoc; W Kremers; T M Therneau; C L Kosberg; G D'Amico; E R Dickson; W R Kim Journal: Hepatology Date: 2001-02 Impact factor: 17.425
Authors: Alan D Dangour; Elizabeth Breeze; Robert Clarke; Prakash S Shetty; Ricardo Uauy; Astrid E Fletcher Journal: J Nutr Date: 2008-06 Impact factor: 4.798
Authors: Jose L Flores-Guerrero; Isidor Minovic; Dion Groothof; Eke G Gruppen; Ineke J Riphagen; Jenny Kootstra-Ros; Anneke Muller Kobold; Eelko Hak; Gerjan Navis; Ron T Gansevoort; Martin H de Borst; Robin P F Dullaart; Stephan J L Bakker Journal: JAMA Netw Open Date: 2020-01-03