SHOULD SERUM FOLATE BE A ROUTINE TEST IN A CRITICALLY ILL PATIENTS?
Year 2024,
Volume: 33 Issue: 3, 331 - 335
Zuhal Ozer Simsek
,
Kaniye Aydın
,
Ali Çetinkaya
Abstract
In intensive care patients, there is an increased consumption and need for folate due to sepsis, comorbid conditions, and malnutrition. The aim of our study was planned to investigate the frequency of folate deficiency in intensive care patients. The data of the 100 patients was collected between June 2019 and September 2019. Serum folate levels were defined as normal above 4 ng/mL, 2-4 ng/mL borderline and below 2 ng/mL deficiency. Serum folate deficiency (<2 ng/mL) was detected in 19 patients (31.6% (6 patients) was female and 68.4% (13 patients) was male. Hypertension was most frequently comorbidities together with folate deficiency. There was a significant negative correlation between folate levels and "Acute Physiology and Chronic Health Evaluation (APACHE)" II scores. A high APACHE II score may be an important predictive factor for folate deficiency. Current reference ranges may cause folate malnutrition. For intensive care patients, it may be necessary to set new threshold values for folate deficiency.
References
- Green R, Datta Mitra A. Megaloblastic Anemias: Nutritional and Other Causes. Med Clin North Am. 2017;101(2):297-317. doi:10.1016/j.mcna.2016. 09.013.
- Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513. doi:10.1111/bjh.12959.
- Reynolds EH. The neurology of folic acid deficiency. Handb Clin Neurol. 2014;120:927-943. doi:10.1016/B978-0-7020-4087-0.00061-9.
- Gudgeon P, Cavalcanti R. Folate testing in hospital inpatients. Am J Med. 2015;128(1):56-59. doi:10.10 16/j.amjmed.2014.08.020.
- Sobczyńska-Malefora A, Harrington DJ. Laboratory assessment of folate (vitamin B9) status. J Clin Pathol.2018;71(11):949-956. doi:10.1136/jclin path-2018-205048.
- Green R, Datta Mitra A. Megaloblastic Anemias: Nutritional and Other Causes. Med Clin North Am. 2017;101(2):297-317. doi:10.1016/j.mcna.2016. 09.013.
- Antony A. Megaloblastic anemias. Hematology: basic principles and practice: Elsevier Inc.; 2017:514-545. e517. doi:10.10.16/B978-0-323-35762-3.00039-1
- Yuan S, Mason AM, Carter P, Burgess S, Larsson SC. Homocysteine, B vitamins, and cardiovascular disease: a Mendelian randomization study. BMC Med. 2021;19(1):97. doi:10.1186/s12916-021-01 977-8.
- Rudreshkumar KJ, Majumdar V, Nagaraja D, et al. Relevance of plasma levels of free homocysteine and methionine as risk predictors for ischemic stroke in the young. Clin Nutr. 2018;37(5):1715-1721. doi:10.1016/j.clnu.2017.07.005.
- Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015;52(4):261-269. doi:10.1053/j.seminhematol.2015. 07.006.
- Boles JM, Youinou P, Garré M, et. al. Folic acid deficiency: incidence in 480 patients. Effects on phagocytosis of polymorphonuclear neutrophils. Rev Med Interne. 1982 Mar;3(1):51-6. French. doi: 10.1016/s0248-8663(82)80008-8.
- Sobczyńska-Malefora A, Harrington DJ. Laboratory assessment of folate (vitamin B9) status. J Clin Pathol. 2018;71(11):949-956. doi:10.1136/jclin path-2018-205048.
- Singh G, Hamdan H, Singh V. Clinical utility of serum folate measurement in tertiary care patients: Argument for revising reference range for serum folate from3.0 ng/mL to 13.0 ng/mL. Pract Lab Med.2015;1:35-41. doi:10.1016/j.plabm.2015.03. 005.
- Ma Y, Peng D, Liu C, Huang C, Luo J. Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases. BMC Cardiovasc Disord. 2017;17(1):37. doi:10.1186/s12872-017-0475-8.
- Safi J, Joyeux L, Chalouhi GE. Periconceptional folate deficiency and implications in neural tube defects. J Pregnancy. 2012;295083. doi:10.1155/ 2012/295083.
- Campillo B, Zittoun J, de Gialluly E. Prophylaxis of folate deficiency in acutely ill patients: results of a randomized clinical trial. Intensive Care Med. 1988;14(6):640-5. doi:10.1007/BF00256769.
- Keskin, O., Keskin, A. S., & Kurklu, N. S. (2022). Association between low serum folic acid and vitamin B12 levels with COVID-19 prognosis. Progress In Nutrıtıon, 24(3).
- Socha DS, DeSouza SI, Flagg A, Sekeres M, Rogers HJ. Severe megaloblastic anemia: Vitamin deficiency and other causes. Cleve Clin J Med. 2020;87(3):153-164. doi:10.3949/ccjm.87a.19072
SERUM FOLAT KRİTİK HASTALARDA RUTİN BİR TEST OLMALI MI?
Year 2024,
Volume: 33 Issue: 3, 331 - 335
Zuhal Ozer Simsek
,
Kaniye Aydın
,
Ali Çetinkaya
Abstract
Yoğun bakım hastalarında sepsis, komorbid durumlar, malnütrisyon gibi nedenlerle artan folat tüketimi ve ihtiyacı vardır. Çalışmamız yoğun bakım hastalarında folat eksikliğinin sıklığını araştırmak amacıyla planlandı. Yüz hastanın verileri Haziran 2019 ile Eylül 2019 arasında toplandı. Serum folat düzeyleri 4 ng/mL üzeri normal, 2-4 ng/mL sınırda ve 2 ng/mL altı eksiklik olarak tanımlandı. Serum folat eksikliği (<2 ng/mL) 19 hastada (%31.6 (6 hasta) kadın, %68.4 (13 hasta) erkek saptandı. Hipertansiyon folat eksikliğine en sık eşlik eden komorbid hastalıktı. Folat düzeyleri ile "Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE)" II puanları arasında anlamlı negatif korelasyon vardı. Yüksek APACHE II skoru, folat eksikliği için önemli bir öngörücü faktör olabilir. Mevcut referans aralıkları folat malnütrisyonuna neden olabilir. Yoğun bakım hastaları için folat eksikliği için yeni eşik değerlerin belirlenmesi gerekebilir.
References
- Green R, Datta Mitra A. Megaloblastic Anemias: Nutritional and Other Causes. Med Clin North Am. 2017;101(2):297-317. doi:10.1016/j.mcna.2016. 09.013.
- Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513. doi:10.1111/bjh.12959.
- Reynolds EH. The neurology of folic acid deficiency. Handb Clin Neurol. 2014;120:927-943. doi:10.1016/B978-0-7020-4087-0.00061-9.
- Gudgeon P, Cavalcanti R. Folate testing in hospital inpatients. Am J Med. 2015;128(1):56-59. doi:10.10 16/j.amjmed.2014.08.020.
- Sobczyńska-Malefora A, Harrington DJ. Laboratory assessment of folate (vitamin B9) status. J Clin Pathol.2018;71(11):949-956. doi:10.1136/jclin path-2018-205048.
- Green R, Datta Mitra A. Megaloblastic Anemias: Nutritional and Other Causes. Med Clin North Am. 2017;101(2):297-317. doi:10.1016/j.mcna.2016. 09.013.
- Antony A. Megaloblastic anemias. Hematology: basic principles and practice: Elsevier Inc.; 2017:514-545. e517. doi:10.10.16/B978-0-323-35762-3.00039-1
- Yuan S, Mason AM, Carter P, Burgess S, Larsson SC. Homocysteine, B vitamins, and cardiovascular disease: a Mendelian randomization study. BMC Med. 2021;19(1):97. doi:10.1186/s12916-021-01 977-8.
- Rudreshkumar KJ, Majumdar V, Nagaraja D, et al. Relevance of plasma levels of free homocysteine and methionine as risk predictors for ischemic stroke in the young. Clin Nutr. 2018;37(5):1715-1721. doi:10.1016/j.clnu.2017.07.005.
- Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015;52(4):261-269. doi:10.1053/j.seminhematol.2015. 07.006.
- Boles JM, Youinou P, Garré M, et. al. Folic acid deficiency: incidence in 480 patients. Effects on phagocytosis of polymorphonuclear neutrophils. Rev Med Interne. 1982 Mar;3(1):51-6. French. doi: 10.1016/s0248-8663(82)80008-8.
- Sobczyńska-Malefora A, Harrington DJ. Laboratory assessment of folate (vitamin B9) status. J Clin Pathol. 2018;71(11):949-956. doi:10.1136/jclin path-2018-205048.
- Singh G, Hamdan H, Singh V. Clinical utility of serum folate measurement in tertiary care patients: Argument for revising reference range for serum folate from3.0 ng/mL to 13.0 ng/mL. Pract Lab Med.2015;1:35-41. doi:10.1016/j.plabm.2015.03. 005.
- Ma Y, Peng D, Liu C, Huang C, Luo J. Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases. BMC Cardiovasc Disord. 2017;17(1):37. doi:10.1186/s12872-017-0475-8.
- Safi J, Joyeux L, Chalouhi GE. Periconceptional folate deficiency and implications in neural tube defects. J Pregnancy. 2012;295083. doi:10.1155/ 2012/295083.
- Campillo B, Zittoun J, de Gialluly E. Prophylaxis of folate deficiency in acutely ill patients: results of a randomized clinical trial. Intensive Care Med. 1988;14(6):640-5. doi:10.1007/BF00256769.
- Keskin, O., Keskin, A. S., & Kurklu, N. S. (2022). Association between low serum folic acid and vitamin B12 levels with COVID-19 prognosis. Progress In Nutrıtıon, 24(3).
- Socha DS, DeSouza SI, Flagg A, Sekeres M, Rogers HJ. Severe megaloblastic anemia: Vitamin deficiency and other causes. Cleve Clin J Med. 2020;87(3):153-164. doi:10.3949/ccjm.87a.19072