Increased fasting total homocysteine plasma levels as a risk factor for hromboembolism in children
Andrea Kosch (1)* , Hans Georg Koch (2)* , Achim Heinecke (3) , Karin Kurnik (4) , Christine Heller (5) , Ulrike Nowak-Göttl (1) , for the Childhood Thrombophilia Study Group
(1) Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, Germany (2) Department of Pediatrics, University Children’s Hospital Münster, Germany (3) Institute of Medical Informatics and Biomathematics, University of Mün
Elevated total homocysteine (tHcy) concentrations are an inde-pendent risk factor for thromboembolic events in adults. In children with moderate hyperhomocysteinemia data are sparse. Therefore, between 1995 and 2002 we consecutively recruited 163 white pediatric patients with a first symptomatic thromboembolic event and 255 healthy controls (mean age: 6.4 years in patients vs. 6.6 years in controls, range: 3 months to 18 years) and measured fasting tHcy levels. Median tHcy levels in patients were significantly higher (6.6 µmol/l, range 2.9-20.4 µmol/l) than in controls (5.7 µmol/l, 2.0-14.0 µmol/l, p<0.0001). 48 of the 163 patients with thromboembolism (29.5%) versus 26 of the 255 controls (10.2%) had tHcy levels above the age-specific normal 90th percentile (OR 2.9, 95%CI: 1.7-4.8). The odds ratio for children in the highest quintile compared to children with levels in the lowest quintile was 4.3 (1.6-8.1; highest quintile: median tHcy level 9.6 µmol, range 8.0-20.4), showing a significantly increased risk for thromboembolic disease with even mild hyperhomocysteinemia. We conclude that hyperho-mocysteinemia above the age-specific cut-off values is a risk factor for thromboembolic events in children. Therefore, screening for elevated fasting tHcy levels of patients with thromboem-bolism is recommended to stratify the risk of thromboembolism.