Elevated Serum Cobalamin (B12) Levels Identify a Sicker Population of Patients With Advanced Heart Failure

Abstract

IntroductionElevated serum cobalamin (B12) has been associated with advanced liver dysfunction and malignancy. Little is know about serum B12 in advanced heart failure.MethodsWe examined 115 consecutive patients with advanced heart failure undergoing considerations for advanced therapies including hemodynamic evaluation. Patients receiving B12 injections were excluded. Serum B12 >900pg/mL values are considered as elevated levels.ResultsMean and median serum B12 levels were 843± 362 pg/mL, and 795 pg/mL (IQR 551-1046), respectively. Patients with elevated values (37% of population) were more likely to be older, with wider red cell distribution width (RDW), higher total bilirubin (albeit similar blood urea nitrogen), and lower mixed-venous oxygen saturation (all p≤0.05). At 2 years follow-up, patients with serum B12 >900pg/mL had reduced survival compared to those with ≤900pg/mL (51% versus 80%, respectively; p=0.006). Serum B12 was found to be an independent predictor for all-cause mortality after adjusting above-mentioned covariates (Hazard ratio 1.02, p=0.04). See Figure 1 for adjusted survival analysis.Conclusions IntroductionElevated serum cobalamin (B12) has been associated with advanced liver dysfunction and malignancy. Little is know about serum B12 in advanced heart failure. Elevated serum cobalamin (B12) has been associated with advanced liver dysfunction and malignancy. Little is know about serum B12 in advanced heart failure. MethodsWe examined 115 consecutive patients with advanced heart failure undergoing considerations for advanced therapies including hemodynamic evaluation. Patients receiving B12 injections were excluded. Serum B12 >900pg/mL values are considered as elevated levels. We examined 115 consecutive patients with advanced heart failure undergoing considerations for advanced therapies including hemodynamic evaluation. Patients receiving B12 injections were excluded. Serum B12 >900pg/mL values are considered as elevated levels. ResultsMean and median serum B12 levels were 843± 362 pg/mL, and 795 pg/mL (IQR 551-1046), respectively. Patients with elevated values (37% of population) were more likely to be older, with wider red cell distribution width (RDW), higher total bilirubin (albeit similar blood urea nitrogen), and lower mixed-venous oxygen saturation (all p≤0.05). At 2 years follow-up, patients with serum B12 >900pg/mL had reduced survival compared to those with ≤900pg/mL (51% versus 80%, respectively; p=0.006). Serum B12 was found to be an independent predictor for all-cause mortality after adjusting above-mentioned covariates (Hazard ratio 1.02, p=0.04). See Figure 1 for adjusted survival analysis. Mean and median serum B12 levels were 843± 362 pg/mL, and 795 pg/mL (IQR 551-1046), respectively. Patients with elevated values (37% of population) were more likely to be older, with wider red cell distribution width (RDW), higher total bilirubin (albeit similar blood urea nitrogen), and lower mixed-venous oxygen saturation (all p≤0.05). At 2 years follow-up, patients with serum B12 >900pg/mL had reduced survival compared to those with ≤900pg/mL (51% versus 80%, respectively; p=0.006). Serum B12 was found to be an independent predictor for all-cause mortality after adjusting above-mentioned covariates (Hazard ratio 1.02, p=0.04). See Figure 1 for adjusted survival analysis. Conclusions