Elevated b12 levels
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Elevated Vitamin B12 Levels: Implications and Associations
Elevated Vitamin B12 and Cancer Risk
Elevated vitamin B12 levels have been linked to an increased risk of cancer. A study conducted using the UK Health Improvement Network primary care database found that individuals with plasma B12 levels above 1,000 pmol/L had a significantly higher 1-year cancer risk compared to those with normal B12 levels. This association was particularly strong for liver cancer, pancreatic cancer, and myeloid malignancies 1. The study suggests that elevated B12 levels may serve as a marker for occult cancer, indicating that some cancers might affect B12 metabolism 1.
Elevated B12 in Chronic Diseases
High B12 levels are also associated with various chronic diseases. For instance, elevated B12 levels have been observed in patients with chronic stable heart failure, where it is considered a marker for subclinical liver damage and impaired prognosis 8. Similarly, patients with acute-on-chronic liver failure (AoCLF) showed significantly higher B12 levels, which were associated with increased disease severity and higher 3-month mortality rates 5. Elevated B12 levels in these conditions may reflect underlying liver dysfunction or other metabolic disturbances.
Elevated B12 and Mortality in Hospitalized Patients
Several studies have highlighted the association between elevated B12 levels and increased mortality in hospitalized patients. In critically ill medical patients, higher B12 levels were linked to increased 90-day mortality, suggesting that B12 levels should be included in the work-up of intensive care patients 7. Another study found that elevated B12 levels were independent predictors of in-hospital mortality and longer lengths of stay in adult patients at nutritional risk 6. These findings underscore the potential prognostic value of B12 levels in clinical settings.
Non-Cancerous Causes of Elevated B12
Elevated B12 levels can also result from non-cancerous conditions. For example, a case report described a 73-year-old woman with persistently high B12 levels due to cobalamin macrocomplexes, which are complexes of B12 bound to carrier proteins or immunoglobulins 2. This condition can lead to spurious B12 results and is often associated with various diseases, including myeloproliferative syndromes and autoimmune disorders 2.
Elevated B12 in Children with Cerebral Palsy
Interestingly, elevated B12 levels have been observed in children with cerebral palsy, particularly those on antiepileptic drugs like valproic acid. The exact cause of this elevation is unclear, but it may be related to changes in gut microbiota or subclinical inflammation 3. This finding highlights the need for careful interpretation of B12 levels in pediatric populations.
Diagnostic and Prognostic Implications
The presence of elevated B12 levels should prompt further investigation to rule out serious underlying conditions. Elevated B12 has been associated with oncohematological diseases, with significantly higher odds of myeloid leukemia in patients with elevated B12 levels compared to those with normal levels 10. Additionally, elevated B12 levels in patients with pernicious anemia can lead to spurious results, complicating the diagnosis 9.
Conclusion
Elevated vitamin B12 levels are associated with a range of serious health conditions, including cancer, chronic liver disease, heart failure, and increased mortality in hospitalized patients. While elevated B12 can sometimes result from benign causes, it often indicates underlying pathology that warrants further investigation. Clinicians should be aware of the potential implications of high B12 levels and consider them in the context of the patient's overall health and clinical presentation.
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Most relevant research papers on this topic
Elevated Vitamin B12 Levels and Cancer Risk in UK Primary Care: A THIN Database Cohort Study
Elevated vitamin B12 levels are associated with a higher 1-year cancer risk in UK primary care, suggesting some cancers may affect B12 metabolism.
Observational StudyPersistently increased vitamin B12 concentration due to cobalamin macrocomplexes: a case report and review of the literature
High vitamin B12 levels in a 73-year-old woman were due to cobalamin macrocomplexes, not a deficiency or supplementation.
Case ReportHigh levels of vitamin B12 are fairly common in children with cerebral palsy
High vitamin B12 levels are common in children with cerebral palsy, particularly in those on antiepileptic drugs, and may be linked to weight loss and gut bacteria production.
Observational StudySupraphysiological vitamin B12 serum concentrations without supplementation: the pitfalls of interpretation
High serum vitamin B12 levels without supplementation may indicate severe underlying diseases and may serve as diagnostic markers.
Serum vitamin B12 levels as indicators of disease severity and mortality of patients with acute-on-chronic liver failure.
Elevated vitamin B12 levels are associated with increased liver disease severity and a higher 3-month mortality rate in acute-on-chronic liver failure patients.
Observational StudyElevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk
Elevated vitamin B12 concentrations are independently associated with increased in-hospital mortality and longer length of stay in adult patients at nutritional risk.
Observational Study
Very Rigorous Journal
Highly CitedIncreased Vitamin B12 levels are associated with mortality in critically ill medical patients.
High serum Vitamin B12 levels are associated with increased mortality in critically ill medical patients.
Observational StudyElevated levels of vitamin B12 in chronic stable heart failure: a marker for subclinical liver damage and impaired prognosis
Elevated vitamin B12 levels in stable heart failure patients are associated with increased direct bilirubin due to right HF, but neither vitamin B12 nor folic acid are independently associated with mortality.
Observational Study
Rigorous JournalSpurious elevations of vitamin B12 with pernicious anemia.
Vitamin B12 levels may be spuriously elevated in patients with pernicious anemia, indicating a need for further laboratory tests to confirm the diagnosis.
Case ReportAssociation of elevated vitamin B12 with oncohematological diseases in a cohort of 79,524 patients from Latvia.
Elevated total vitamin B12 levels may serve as a potential diagnostic marker for oncohematological disorders, with a higher odds ratio for myeloid leukemia compared to the control group.
Observational Study