Serum Homocysteine as an Etiology-dependent Marker of Disease Severity in Alcoholic and Viral Liver Cirrhosis: A Cross-sectional Study.

BACKGROUND AND AIM: Serum homocysteine is frequently elevated in chronic liver disease, but its prognostic relevance and etiology-specific associations in cirrhosis remain uncertain. This study aimed to compare fasting serum homocysteine levels in alcoholic and viral cirrhosis and to evaluate their association with disease severity.

MATERIALS AND

METHODS

This cross-sectional observational study included 60 adult cirrhosis patients (30 alcoholic and 30 viral hepatitis B or C-related) enrolled at a tertiary care center. Cirrhosis was diagnosed clinically, radiologically, and by transient elastography. Fasting serum homocysteine, Vitamin B12, and folate levels were measured. Disease severity was assessed using Child-Turcotte-Pugh (CTP) and MELD-Na scores. Correlation analysis, receiver operating characteristic (ROC) analysis, multivariable regression, interaction models, and etiology-stratified analyses were performed.

RESULTS

Median serum homocysteine levels were comparable between alcoholic and viral cirrhosis (13.76 vs. 12.85 μmol/L; P = 0.095). Overall, homocysteine showed no significant correlation with CTP score (ρ=0.131; P = 0.319) or MELD-Na score (ρ=0.212; P = 0.103). In viral cirrhosis, homocysteine correlated positively with CTP score (ρ=0.399; P = 0.029) and independently predicted CTP class C (adjusted OR = 1.163; 95% CI 1.005-1.346; P = 0.043). No independent association was observed in alcoholic cirrhosis. Discriminatory performance of homocysteine for severe cirrhosis was limited (area under the curve = 0.542 for CTP C and 0.615 for MELD-Na ≥20).

CONCLUSIONS

Serum homocysteine is not a universal marker of cirrhosis severity but may have etiology-dependent relevance, with stronger associations observed in viral cirrhosis.