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Thromb Haemost 2022; 122(07): 1209-1220
DOI: 10.1055/s-0041-1740637
Stroke, Systemic or Venous Thromboembolism

Plasma Homocysteine in Behcet's Disease: A Systematic Review and Meta-Analysis

Mira Merashli
1   Department of Rheumatology, American University of Beirut, Bliss, Beirut, Lebanon
,
Tommaso Bucci
2   Department of General Surgery, Surgical Specialties and Organ Transplantation “Paride Stefanini,” Sapienza University of Rome, Rome, Italy
,
Daniele Pastori
3   Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Pasquale Pignatelli
3   Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
,
Alessia Arcaro
4   Department of Medicine and Health Sciences ‘V. Tiberio’, Università del Molise, Campobasso, Italy
,
Fabrizio Gentile
4   Department of Medicine and Health Sciences ‘V. Tiberio’, Università del Molise, Campobasso, Italy
,
Vincenzo Marottoli
5   Multimedica SRL, Naples, Italy
,
Paul R. J. Ames 
6   Immune Response and Vascular Disease Unit, CEDOC, Nova University Lisbon, Rua Camara Pestana, Lisbon Portugal
7   Department of Haematology, Dumfries Royal Infirmary, Cargenbridge, Dumfries, United Kingdom
› Author Affiliations Funding This work was supported by Fondazione Anticorpi Antifosfolipidi ONLUS (www.fondazioneaps.org), an Italian registered charity organization that had no role in the systematic review.
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Abstract

Aim To evaluate the relevance of plasma homocysteine (HC) in Behcet's disease (BD) and its clinical manifestations.

Methods Systematic review of EMBASE and PubMed databases according to PRISMA guidelines from inception to July 2021; random-effects meta-analyses for continuous outcomes.

Results The search strategy retrieved 48 case–control (2,669 BD and 2,245 control participants) and 5 cohort studies (708 BD participants). Plasma HC was higher in BD than in controls (p < 0.0001) with wide heterogeneity (I2  = 89.7%) that remained unchanged after sensitivity analysis according to year of article publication, age of BD participants, study size, study quality, method of HC determination, and male/female ratio >1.5; some pooled ethnicities explained a small part of the heterogeneity (I2  = 16.3%). Active BD participants had higher HC than inactive ones (p < 0.0001), with moderate heterogeneity (I2  = 49.2%) that disappeared after removal of an outlier study with very high disease activity. BD participants with any vascular involvement had higher HC than those without (p < 0.0001) with wide heterogeneity (I2  = 89.7%); subgroup analysis on venous thrombosis only changed neither effect size (p < 0.0001) nor heterogeneity (I2  = 72.7%). BD participants with ocular involvement had higher HC than those without (p < 0.0001) with moderate heterogeneity (I2  = 40.3%).

Conclusion Although causality cannot be inferred, the consistency of the elevation of plasma HC in BD, particularly in patients with active disease, with vascular and ocular involvement suggests an intrinsic involvement of HC in these clinical manifestations.

Keywords

Behcet's disease - homocysteine - disease activity

Supplementary Material



Publication History

Received: 25 September 2021

Accepted: 11 November 2021

Article published online:
07 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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