BACKGROUND: Galectin-3 (GAL3) is linked to the prognosis of patients with heart failure and after heart transplantation (HTx). We assessed the prognostic role of GAL3 in a long-term follow-up after HTx. METHODS: HTx patients (N = 121) were evaluated in a single-center, noninterventional, prospective, observational study. The median follow-up was 96 months (2942 days, interquartile range (IQR) 2408-3264 days), and 40 patients died. GAL3 was measured before HTx, +10 days after HTx, and during the first posttransplant year. Survival analysis (all-cause mortality) was performed with adjustments for clinical and laboratory variables. RESULTS: The median pretransplant GAL3 level was 18.0 μg/L (IQR 14.0-25.9), and higher values were associated with older age, worse kidney function, left ventricular assist device use before HTx, a higher IMPACT score, and mortality. Increased pretransplant GAL3 predicted shorter survival time (HR 2.05, 95% CI 1.09-3.85, p < .05). Similar prognostic power had GAL3 on the 10th posttransplant day (HR 2.03, 95% CI 1.08-3.82, p < .05). GAL3 was an independent predictor of death after adjustment for clinical variables (age, infection, diabetes, smoking, IMPACT score, and troponin). CONCLUSIONS: GAL3 was significantly associated with all-cause mortality after adjusting for clinical and laboratory variables and may serve as an additional prognostic biomarker.
Sepsis biomarkers change continuously during the postoperative period. We aimed to demonstrate the influence of immunosuppressants after transplantation (Tx) on presepsin, procalcitonin, CRP, white blood cells, and IL-6. A group of 140 patients after major surgery (86 non-Tx, 54 Tx) without any signs of sepsis or infectious complications was followed for 7 days. The changes in biomarkers were analyzed with respect to the type of surgery, organ, and induction immunosuppressant used (antithymocyte globulin, corticosteroids, or basiliximab/rituximab). Concentrations (95th percentiles) of presepsin and procalcitonin were higher in the Tx group (presepsin: Tx < 2380 vs. non-Tx < 1368 ng/L, p < 0.05; procalcitonin: <28.0 vs. 3.49 μg/L, p < 0.05). In contrast, CRP and IL-6 were lower in the Tx group (CRP: Tx < 84.2 vs. non-Tx < 229 mg/L, p < 0.05; IL-6: <71.2 vs. 317 ng/L, p < 0.05). Decreases in CRP and IL-6 were found for all immunosuppressants, and procalcitonin was increased after antithymocyte globulin and corticosteroids. Negligible changes were found for white blood cells. Different responses of presepsin, procalcitonin, CRP, and IL-6 were therefore found in patients without any infectious complications after major surgery or transplantation. Immunosuppression decreased significantly IL-6 and CRP in comparison to non-Tx patients, while procalcitonin was increased after corticosteroids and antithymocyte globulin only. Cautious interpretation of sepsis biomarkers is needed in the early posttransplant period. This work was conducted as a noninterventional (nonregistered) study.
- MeSH
- biologické markery krev MeSH
- C-reaktivní protein metabolismus MeSH
- imunosupresiva terapeutické užití MeSH
- interleukin-6 krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- sepse krev MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Autoři popisují současný stav rutinní laboratorní diagnostiky kardiovaskulárního rizika se zaměřením na metrologii, návaznost měření, externí hodnocení kvality, biologickou variabilitu a kritickou diferenci po sobě jdoucích měření. Zatímco v případě cholesterolu, triacylglycerolů, glukózy a HbA1c je analytická spolehlivost vyhovující, u HDL-cholesterolu, LDL-cholesterolu, apolipoproteinu A1, apolipoproteinu B, Lp(a) a LpPLA2 je prostor pro zlepšení porovnatelnosti výsledků měření. Biologická variabilita významně ovlivňuje interpretaci výsledků lipidového profilu, protože kritická diference dvou po sobě jdoucích měření je u většiny parametrů vyšší než 20 %. Současná metodologie stanovení remnantního cholesterolu není standardizována.
Authors describe state-of-the-art in the routine laboratory diagnostics of cardiovascular risk with special emphasis on metrology, traceability, external quality assessment, biological variation, and reference change value. While analytical quality of total cholesterol, triglycerides, glucose, and HbA1c is satisfactory, improvements are needed for HDL-cholesterol, LDL-cholesterol, apolipoprotein A1, apolipoprotein B, Lp(a), and LpPLA2 measurements. Biological variation is a strong player in the lipid diagnostics, because reference change value is above 20 % for majority of biomarkers. Current methodology for the measurement of remnant cholesterol is far from optimum and standardization is therefore needed.
- Klíčová slova
- remnantní cholesterol,
- MeSH
- ateroskleróza diagnóza MeSH
- biochemická analýza krve MeSH
- cholesterol krev MeSH
- kardiovaskulární nemoci * diagnóza MeSH
- klinické laboratorní techniky metody MeSH
- lidé MeSH
- lipidy analýza krev MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Differentiation between systemic inflammatory response syndrome and sepsis in surgical patients is of crucial significance. Procalcitonin (PCT) and C-reactive protein (CRP) are widely used biomarkers, but PCT becomes compromised after antithymocyte globulin (ATG) administration, and CRP exhibits limited specificity. Presepsin has been suggested as an alternative biomarker of sepsis. This study aimed to demonstrate the role of presepsin in patients after heart transplantation (HTx). Plasma presepsin, PCT, and CRP were measured in 107 patients serially for up to 10 days following HTx. Time responses of biomarkers were evaluated for both noninfected (n=91) and infected (n=16) patients. Areas under the concentration curve differed in the two groups of patients for presepsin (P<.001), PCT (P<.005), and CRP (P<.001). The effect of time and infection was significant for all three biomarkers (P<.05 all). In contrast to PCT, presepsin was not influenced by ATG administration. More than 25% of noninfected patients had PCT above 42 μg/L on the first day, and the peak concentration of CRP in infected patients was reached on the third post-transplant day (median 135 mg/L). Presepsin seems to be as valuable a biomarker as PCT or CRP in the evaluation of infectious complications in patients after HTx.
- MeSH
- antilymfocytární sérum aplikace a dávkování MeSH
- biologické markery metabolismus MeSH
- C-reaktivní protein metabolismus MeSH
- dospělí MeSH
- imunosupresiva aplikace a dávkování MeSH
- infekční nemoci farmakoterapie etiologie metabolismus MeSH
- kalcitonin metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipopolysacharidové receptory metabolismus MeSH
- následné studie MeSH
- peptidové fragmenty metabolismus MeSH
- pooperační komplikace farmakoterapie etiologie metabolismus MeSH
- přežívání štěpu účinky léků MeSH
- prognóza MeSH
- rizikové faktory MeSH
- studie případů a kontrol MeSH
- transplantace srdce škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- časná diagnóza MeSH
- fenotyp MeSH
- genetické testování MeSH
- hodnocení rizik MeSH
- hyperlipoproteinemie typ II * diagnóza epidemiologie genetika prevence a kontrola MeSH
- kardiovaskulární nemoci prevence a kontrola MeSH
- LDL-cholesterol genetika metabolismus MeSH
- lidé MeSH
- mutace genetika MeSH
- plošný screening * MeSH
- programy Healthy People MeSH
- registrace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodní články MeSH
- Geografické názvy
- Česká republika MeSH
- Klíčová slova
- Darapladib,
- MeSH
- biologické markery * MeSH
- fosfolipasy A * analýza MeSH
- inhibitory fosfolipasy A2 farmakologie terapeutické užití MeSH
- kardiovaskulární nemoci * diagnóza farmakoterapie MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- MeSH
- apolipoproteiny krev MeSH
- cholesterol analýza krev MeSH
- HDL-cholesterol * analýza krev MeSH
- klinická studie jako téma MeSH
- LDL-cholesterol * analýza krev MeSH
- lidé MeSH
- lipidy krev MeSH
- lipoproteiny krev MeSH
- odběr vzorku krve * metody MeSH
- omezení příjmu potravy krev MeSH
- postprandiální období * fyziologie MeSH
- prediktivní hodnota testů MeSH
- přijímání potravy fyziologie MeSH
- triglyceridy * analýza krev MeSH
- Check Tag
- lidé MeSH
- MeSH
- deriváty kyseliny fibrové * farmakologie škodlivé účinky terapeutické užití MeSH
- hodnoty glomerulární filtrace účinky léků MeSH
- klinické laboratorní techniky MeSH
- kreatinin * krev MeSH
- ledviny metabolismus účinky léků MeSH
- lidé MeSH
- renální oběh účinky léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
C-reactive protein (CRP) is a marker of arterial inflammation while lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is related to plaque instability. The aim of this study was to evaluate the correlation between the risk of unstable plaque presenting as acute coronary syndrome (ACS) and Lp-PLA(2), and to assess the influence of statins on interpretation of Lp-PLA(2). A total of 362 consecutive patients presenting to the emergency department (ED) with acute chest pain suggestive of ACS were evaluated by cardiologists as STEMI, NSTEMI, or unstable angina, and non-ACS. Serum biomarkers measured on admission: troponin I, C-reactive protein (Abbott), and Lp-PLA(2) (DiaDexus). Four groups were defined according to the final diagnosis and history of statin medication: ACS/statin-; ACS/statin+; non-ACS/statin-; non-ACS/statin+. Lp-PLA(2) was highest in ACS/statin- group; statins decreased Lp-PLA(2) both in ACS and non-ACS of about 20 %. Lp-PLA(2) was higher in ACS patients in comparison with non-ACS patients group without respect to statin therapy (p<0.001). Lp-PLA(2) predicted worse outcome (in terms of acute coronary syndrome) effectively in patients up to 62 years; limited prediction was found in older patients. C-reactive protein (CRP) failed to discriminate four groups of patients. Statin therapy and age should be taken into consideration while interpreting Lp-PLA(2) concentrations and lower cut-off values should be used for statin-treated persons.
- MeSH
- akutní koronární syndrom krev diagnóza MeSH
- aterosklerotický plát krev farmakoterapie MeSH
- C-reaktivní protein analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- plocha pod křivkou MeSH
- prediktivní hodnota testů MeSH
- senioři MeSH
- stárnutí metabolismus fyziologie MeSH
- statiny terapeutické užití MeSH
- thiolesterhydrolasy krev MeSH
- troponin I krev MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
