背景:数据表明维生素B12通过不同的途径具有免疫调节作用,这可能会影响败血症的病理生理学。这项研究的目的是调查维生素B12水平,通过测量全反式巴拉明(HTC)来评估,总维生素B12(B12),和甲基丙二酸(MMA,在B12缺乏的情况下积累),与细菌感染发作患者败血症的发展有关。
方法:这是一个单中心,前瞻性观察性试点研究。将微生物培养阳性结果证实为细菌感染的急诊成年患者纳入研究,并随访6天,以评估他们是否发展为败血症。主要目的是比较发生败血症的患者与未发生败血症的患者的HTC浓度。次要目标是评估这两组中的B12和MMA浓度。使用多元逻辑回归模型,以败血症的存在为结果变量,还有HTC,B12和MMA浓度作为预测变量,分开,并针对潜在的混杂因素进行了调整。
结果:从2019年到2022年,对2131名患者进行了资格评估,其中100人符合入选标准。由于数据缺失,一名患者被排除在分析之外。在99名患者中,29例出现脓毒症。没有证据表明HTC或B12浓度与脓毒症发展之间存在关联(OR0.65,95%CI0.31-1.29,p=0.232,OR0.84,95%CI0.44-1.54,p=0.584)。MMA浓度与脓毒症的发展有关联,具有积极的效果,即随着MMA的增加,败血症的几率增加(OR2.36,95%CI1.21-4.87,p=0.014)。校正混杂因素后,这种关联仍然显著(OR2.72,95%CI1.23-6.60,p=0.018)。
结论:我们的研究发现MMA浓度升高与脓毒症的发展之间存在关联。我们没有发现HTC和B12浓度与脓毒症发展之间的关联。Further,更大的研究是有必要的,因为这可能导致介入性试验调查B12补充是否为感染或脓毒症患者提供临床益处.
背景:该研究于2019年6月17日在ClinicalTrials.gov上以标识符NCT04008446注册。
BACKGROUND: Data have shown that vitamin B12 has immunomodulatory effects via different pathways, which could influence the pathophysiology of sepsis. The objective of this study was to investigate whether vitamin B12 levels, assessed by the measurement of holotranscobalamin (HTC), total vitamin B12 (B12), and methylmalonic acid (MMA, which accumulates in case of B12 deficiency), are associated with the development of sepsis in patients with onset of bacterial infection.
METHODS: This was a single-center, prospective observational pilot study. Adult patients who presented to the emergency department with bacterial infection confirmed by a positive microbiological culture result were included in the study and followed up for 6 days to assess whether they developed sepsis or not. The primary objective was to compare HTC concentration in patients who developed sepsis to those who did not develop sepsis. Secondary objectives were the evaluation of B12 and MMA concentrations in those two groups. Multiple logistic regression models were used, with presence of sepsis as the outcome variable, and HTC, B12, and MMA concentrations as predictor variables, separately, and adjusted for potential confounders.
RESULTS: From 2019 to 2022, 2131 patients were assessed for eligibility, of whom 100 met the inclusion criteria. One patient was excluded from the analysis due to missing data. Of the 99 patients, 29 developed sepsis. There was no evidence for an association between HTC or B12 concentration and the development of sepsis (OR 0.65, 95% CI 0.31-1.29, p = 0.232, OR 0.84, 95% CI 0.44-1.54, p = 0.584, respectively). There was an association between MMA concentration and the development of sepsis, with a positive effect, i.e. with increasing MMA, the odds for sepsis increased (OR 2.36, 95% CI 1.21-4.87, p = 0.014). This association remained significant when adjusted for confounders (OR 2.72, 95% CI 1.23-6.60, p = 0.018).
CONCLUSIONS: Our study found an association between elevated MMA concentration and the development of sepsis. We did not find an association between HTC and B12 concentrations and the development of sepsis. Further, larger studies are warranted, as it could lead to interventional trials investigating whether B12 supplementation provides a clinical benefit to patients with infection or sepsis.
BACKGROUND: The study was registered on ClinicalTrials.gov under the identifier NCT04008446 on June 17, 2019.