101
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Wada H, Dohi T, Miyauchi K, Doi S, Konishi H, Naito R, Tsuboi S, Ogita M, Kasai T, Okazaki S, Isoda K, Suwa S, Daida H. Prognostic impact of nutritional status assessed by the Controlling Nutritional Status score in patients with stable coronary artery disease undergoing percutaneous coronary intervention. Clin Res Cardiol 2017. [PMID: 28634674 DOI: 10.1007/s00392-017-1132-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recently, malnutrition has been shown to be related to worse clinical outcomes in patients with heart failure. However, the association between nutritional status and clinical outcomes in patients with coronary artery disease (CAD) remains unclear. We investigated the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT; range 0-12, higher = worse, consisting of serum albumin, cholesterol and lymphocytes) score in patients with CAD. METHODS The CONUT score was measured on admission in a total of 1987 patients with stable CAD who underwent elective percutaneous coronary intervention (PCI) between 2000 and 2011. Patients were divided into two groups according to their CONUT score (0-1 vs. ≥2). The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated. RESULTS The median CONUT score was 1 (interquartile range 0-2). During the median follow-up of 7.4 years, 342 MACE occurred (17.2%). Kaplan-Meier curves revealed that patients with high CONUT scores had higher rates of MACE (log-rank p < 0.0001). High CONUT scores showed a significant increase in the incidence of MACE compared with low CONUT scores, even after adjusting for confounding factors (hazard ratio: 1.64, 95% confidence interval 1.30-2.07, p < 0.0001). Adding CONUT scores to a baseline model with established risk factors improved the C-index (p = 0.02), net reclassification improvement (p = 0.004) and integrated discrimination improvement (p = 0.0003). CONCLUSIONS Nutritional status assessed by the CONUT score was significantly associated with long-term clinical outcomes in patients with CAD. Pre-PCI assessment of the CONUT score may provide useful prognostic information.
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Affiliation(s)
- Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hirokazu Konishi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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102
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Di Napoli M, Behrouz R, Topel CH, Misra V, Pomero F, Giraudo A, Pennati P, Masotti L, Schreuder FHBM, Staals J, Klijn CJM, Smith CJ, Parry-Jones AR, Slevin MA, Silver B, Willey JZ, Azarpazhooh MR, Vallejo JM, Nzwalo H, Popa-Wagner A, Godoy DA. Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage. J Crit Care 2017; 41:247-253. [PMID: 28599198 DOI: 10.1016/j.jcrc.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/23/2017] [Accepted: 06/01/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE Hypoalbuminemia and systemic inflammatory response syndrome (SIRS) are reported in critically-ill patients, but their relationship is unclear. We sought to determine the association of admission serum albumin and SIRS with outcomes in patients with intracerebral hemorrhage (ICH). METHODS We used a multicenter, multinational registry of ICH patients to select patients in whom SIRS parameters and serum albumin levels had been determined on admission. Hypoalbuminemia was defined as the lowest standardized quartile of albumin; SIRS according to standard criteria. Primary outcomes were modified Rankin Scale (mRS) at discharge and in-hospital mortality. Regression models were used to assess for the association of hypoalbuminemia and SIRS with discharge mRS and in-hospital mortality. RESULTS Of 761 ICH patients included in the registry 518 met inclusion criteria; 129 (25%) met SIRS criteria on admission. Hypoalbuminemia was more frequent in patients with SIRS (42% versus 19%; p<0.001). SIRS was associated with worse outcomes (OR: 4.68, 95%CI, 2.52-8.76) and in-hospital all-cause mortality (OR: 2.18, 95% CI, 1.60-2.97), while hypoalbuminemia was not associated with all-cause mortality. CONCLUSIONS In patients with ICH, hypoalbuminemia is strongly associated with SIRS. SIRS, but not hypoalbuminemia, predicts poor outcome at discharge. Recognizing and managing SIRS early may prevent death or disability in ICH patients.
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Affiliation(s)
- Mario Di Napoli
- Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
| | - Réza Behrouz
- Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Christopher H Topel
- Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Vivek Misra
- Houston Methodist Hospital, Houston, TX, USA
| | - Fulvio Pomero
- Department of Internal Medicine, Ospedale Santa Croce e Carle, Cuneo, Italy
| | - Alessia Giraudo
- Department of Internal Medicine, Ospedale Santa Croce e Carle, Cuneo, Italy
| | - Paolo Pennati
- Department of Internal Medicine, Ospedale Santa Croce e Carle, Cuneo, Italy; Emergency-Urgency Department, Ospedale Livorno, Livorno, Italy
| | - Luca Masotti
- Department of Internal Medicine, Ospedale Santa Maria Nuova, Florence, Italy
| | - Floris H B M Schreuder
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Craig J Smith
- Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, UK; Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Adrian R Parry-Jones
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mark A Slevin
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joshua Z Willey
- Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Mahmoud R Azarpazhooh
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Hipólito Nzwalo
- Stroke Unit, Centro Hospitalar do Algarve, University do Algarve, Algarve, Portugal
| | - Aurel Popa-Wagner
- University of Medicine and Pharmacy Craiova, Romania; Department of Psychiatry, Universitätsmedizin Rostock, Rostock, Germany
| | - Daniel A Godoy
- Neurocritical Care Unit, Sanatorio Pasteur, Catamarca, Argentina; Unidad de Terapia Intensiva, Hospital Interzonal de Agudos "San Juan Bautista", Catamarca, Argentina
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103
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Wada H, Dohi T, Miyauchi K, Shitara J, Endo H, Doi S, Naito R, Konishi H, Tsuboi S, Ogita M, Kasai T, Okazaki S, Isoda K, Suwa S, Daida H. Impact of serum albumin levels on long-term outcomes in patients undergoing percutaneous coronary intervention. Heart Vessels 2017; 32:1085-1092. [PMID: 28429111 DOI: 10.1007/s00380-017-0981-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/14/2017] [Indexed: 12/18/2022]
Abstract
Epidemiological studies have demonstrated an association between low serum albumin levels and both coronary artery disease (CAD) and mortality. However, the long-term clinical impact of low serum albumin level in patients with CAD undergoing percutaneous coronary intervention (PCI) has not yet been fully investigated. We studied 2860 all-comer patients with CAD who underwent their first PCI and had data available for pre-procedural serum albumin between 2000 and 2011. Patients were assigned to tertiles based on pre-procedural albumin levels. We evaluated the incidence of major adverse cardiac events (MACE), including all-cause death and nonfatal myocardial infarction. Mean albumin level was 4.0 ± 0.5 g/dL. Lower albumin levels were associated with older age, lower body mass index (BMI), and higher prevalences of female sex, ACS and chronic kidney disease (CKD). During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of MACE among albumin tertiles (albumin <3.8 g/dl: 44.3% vs. 3.8-4.1 g/dl: 38.0% vs. >4.1 g/dl: 22.9%; log-rank p < 0.0001). After adjusting for established cardiovascular risk factors including age, acute coronary syndrome, BMI and CKD, serum albumin levels were significantly associated with incidence of MACE (HR 1.74 per 1-g/dl decrease, 95% CI 1.34-2.26, p < 0.0001) and all-cause mortality (HR 1.74, 95% CI 1.30-2.33, p = 0.0002). Pre-PCI low serum albumin level was associated with worse long-term outcomes, independent of traditional risk factors. Assessing albumin levels may allow risk stratification in patients with CAD undergoing PCI.
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Affiliation(s)
- Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hirokazu Konishi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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104
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Methods of albumin estimation in clinical biochemistry: Past, present, and future. Clin Chim Acta 2017; 469:150-160. [PMID: 28410855 DOI: 10.1016/j.cca.2017.04.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 12/17/2022]
Abstract
Estimation of serum and urinary albumin is routinely performed in clinical biochemistry laboratories. In the past, precipitation-based methods were popular for estimation of human serum albumin (HSA). Currently, dye-binding or immunochemical methods are widely practiced. Each of these methods has its limitations. Research endeavors to overcome such limitations are on-going. The current trends in methodological aspects of albumin estimation guiding the field have not been reviewed. Therefore, it is the need of the hour to review several aspects of albumin estimation. The present review focuses on the modern trends of research from a conceptual point of view and gives an overview of recent developments to offer the readers a comprehensive understanding of the subject.
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105
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Preidis GA, Kim KH, Moore DD. Nutrient-sensing nuclear receptors PPARα and FXR control liver energy balance. J Clin Invest 2017; 127:1193-1201. [PMID: 28287408 DOI: 10.1172/jci88893] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The nuclear receptors PPARα (encoded by NR1C1) and farnesoid X receptor (FXR, encoded by NR1H4) are activated in the liver in the fasted and fed state, respectively. PPARα activation induces fatty acid oxidation, while FXR controls bile acid homeostasis, but both nuclear receptors also regulate numerous other metabolic pathways relevant to liver energy balance. Here we review evidence that they function coordinately to control key nutrient pathways, including fatty acid oxidation and gluconeogenesis in the fasted state and lipogenesis and glycolysis in the fed state. We have also recently reported that these receptors have mutually antagonistic impacts on autophagy, which is induced by PPARα but suppressed by FXR. Secretion of multiple blood proteins is a major drain on liver energy and nutrient resources, and we present preliminary evidence that the liver secretome may be directly suppressed by PPARα, but induced by FXR. Finally, previous studies demonstrated a striking deficiency in bile acid levels in malnourished mice that is consistent with results in malnourished children. We present evidence that hepatic targets of PPARα and FXR are dysregulated in chronic undernutrition. We conclude that PPARα and FXR function coordinately to integrate liver energy balance.
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106
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Early Postoperative Decrease of Serum Albumin Predicts Surgical Outcome in Patients Undergoing Colorectal Resection. Dis Colon Rectum 2017; 60:326-334. [PMID: 28177996 DOI: 10.1097/dcr.0000000000000750] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A simple and accurate predictor of postoperative complications is needed for early and safe discharge after surgery. A decrease in serum albumin is commonly observed early after surgery, even in patients with normal preoperative levels. However, whether it predicts patient postoperative outcome is unknown. OBJECTIVE The purpose of this study was to evaluate whether the reduction in serum albumin within 2 postoperative days compared with the preoperative level could serve as an independent predictor of postoperative complications after colorectal surgery. DESIGN This was a retrospective study from a single institution. SETTINGS The study was conducted in a tertiary referral hospital. PATIENTS A total of 626 patients undergoing major colorectal surgery between December 2012 and January 2016 were eligible for this study. MAIN OUTCOME MEASURES Univariate and multivariate analyses were performed to identify risk factors for postoperative complications and to identify the factors associated with Δalbumin. Receiver operating characteristic curves were developed to examine the cutoff value of the change in albumin in predicting postoperative complications. RESULTS Among all of the patients, the median Δalbumin after surgery was 15%. ΔAlbumin was an independent risk factor for overall complications (p < 0.01). The cutoff value was 15%, and an increased area under the curve compared with C-reactive protein occurred on postoperative day 3 or 4. Patients with a Δalbumin ≥15% experienced more postoperative major complications, a higher comprehensive complication index, a longer postoperative stay, and increased surgical site infections (p < 0.05) than those <15%. ΔAlbumin correlated with sex, type of surgery, stoma creation, C-reactive protein on postoperative day 3 or 4, and intraoperative blood transfusion. Postoperative C-reactive protein remained independently associated with Δalbumin (p < 0.01). LIMITATIONS The study was limited by its retrospective nature. CONCLUSIONS A cutoff value of a 15% reduction in serum albumin within 2 postoperative days could help to identify patients with a high probability of postoperative complications and permit safe and early discharge after colorectal surgery.
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107
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Park JH, Horgan PG, McMillan DC. In reply to: "Meyer CP et al., The association of hypoalbuminemia with early perioperative outcomes - A comprehensive assessment across 16 major procedures". Am J Surg 2017; 216:174-175. [PMID: 28082008 DOI: 10.1016/j.amjsurg.2016.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 12/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- J H Park
- University Department of Surgery, Royal Infirmary, Level 2, New Lister Building, Castle Street, Glasgow, G4 0SF, UK.
| | - P G Horgan
- University Department of Surgery, Royal Infirmary, Level 2, New Lister Building, Castle Street, Glasgow, G4 0SF, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Level 2, New Lister Building, Castle Street, Glasgow, G4 0SF, UK
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108
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Muraleedharan N, Janardhanan J. Thyroid hormone status in preeclampsia patients: A case–control study. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2017. [DOI: 10.4103/0975-9727.212415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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109
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Komáromi A, Estenberg U, Hammarqvist F, Rooyackers O, Wernerman J, Norberg Å. Simultaneous assessment of the synthesis rate and transcapillary escape rate of albumin in inflammation and surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:370. [PMID: 27846908 PMCID: PMC5111293 DOI: 10.1186/s13054-016-1536-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/18/2016] [Indexed: 12/31/2022]
Abstract
Background Better knowledge of albumin kinetics is needed to define the indications for albumin use in clinical practice. This study involved two approaches: the synthesis rate and transcapillary escape rate of albumin were measured simultaneously at different levels of plasma albumin concentration in relation to acute inflammation and surgery; and two different tracers were compared to determine plasma volume and the transcapillary escape rate. Methods Healthy volunteers (n = 10), patients with acute inflammatory abdominal disease (n = 10), and patients undergoing elective pancreatic resection (n = 10) were studied. The albumin synthesis rate was measured by the incorporation of deuterium-labeled phenylalanine. Plasma volume and the transcapillary escape rate were assessed using 123I-labeled and 125I-labeled albumin. Results A 50 % elevated de-novo albumin synthesis rate was seen in patients with acute inflammation and marked hypoalbuminemia, while patients with marginal hypoalbuminemia before the start of surgery had a normal albumin synthesis rate. The transcapillary escape rate was elevated intraoperatively during the reconstructive phase of pancreatic surgery, when plasma albumin was decreased but stable. In acute inflammation with marked hypoalbuminemia, the transcapillary escape rate was no different from normal. 123I-labeled and 125I-labeled albumin were found exchangeable for plasma volume determinations, but could be used only in groups of patients for the transcapillary escape rate. Conclusions This observational study illustrates the limited information contained in albumin plasma concentrations to reflect albumin kinetics. On the contrary, single measurements of the synthesis rate and/or transcapillary escape rate of albumin obviously cannot explain the plasma level of albumin or the changes seen in plasma albumin concentration. Trial registration www.clinicaltrials.gov, study number NCT01686776. Registered 13 September 2012.
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Affiliation(s)
- András Komáromi
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. .,Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
| | - Ulrika Estenberg
- Department of Nuclear Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Folke Hammarqvist
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Olav Rooyackers
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Jan Wernerman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Åke Norberg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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110
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Hypoalbuminemia: a risk factor for acute kidney injury development and progression to chronic kidney disease in critically ill patients. Int Urol Nephrol 2016; 49:295-302. [DOI: 10.1007/s11255-016-1453-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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111
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Chen Z, Shao Y, Wang K, Cao W, Xiong Y, Wu R, Luo S, Xu X, He X. Prognostic role of pretreatment serum albumin in renal cell carcinoma: a systematic review and meta-analysis. Onco Targets Ther 2016; 9:6701-6710. [PMID: 27822073 PMCID: PMC5094571 DOI: 10.2147/ott.s108469] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Recently, many studies have shown that pretreatment serum albumin can be closely linked to the prognosis of cancer patients, including those with renal cell carcinoma (RCC). However, not all studies have reached the same conclusion. We therefore conducted a systematic review and meta-analysis to evaluate the prognostic value of pretreatment serum albumin in RCC patients. A total of 17 studies involving 6,447 patients were included in our meta-analysis. Our results indicated that a lower pretreatment serum albumin level yielded a worse overall survival (hazard ratio [HR]=2.46, 95% confidence interval [CI] 1.92–3.13), cancer-specific survival (HR=2.22, 95% CI 1.87–2.64), and relapse-free survival/progression-free survival (HR=1.75, 95% CI 1.28–2.38). Generally, these findings were particularly pronounced when stratified by tumor type, analysis type, cut-off value, and HR-obtaining method. In conclusion, a decreased pretreatment serum albumin level implies a poor prognosis for RCC patients, and can be monitored for risk stratification and individualized treatment in RCC patients.
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Affiliation(s)
- Zhen Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Yingjie Shao
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou
| | - Kun Wang
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Wei Cao
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Yulong Xiong
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Rongzu Wu
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Shicheng Luo
- Department of Urology, The Third Affiliated Hospital of Soochow University
| | - Xianlin Xu
- Department of Urology, Sir Run Run Shaw Hospital, Third Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xiaozhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University
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112
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Ahmed U, Anwar A, Savage RS, Thornalley PJ, Rabbani N. Protein oxidation, nitration and glycation biomarkers for early-stage diagnosis of osteoarthritis of the knee and typing and progression of arthritic disease. Arthritis Res Ther 2016; 18:250. [PMID: 27788684 PMCID: PMC5081671 DOI: 10.1186/s13075-016-1154-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/11/2016] [Indexed: 01/15/2023] Open
Abstract
Background There is currently no blood-based test for detection of early-stage osteoarthritis (OA) and the anti-cyclic citrullinated peptide (CCP) antibody test for rheumatoid arthritis (RA) has relatively low sensitivity for early-stage disease. Morbidity in arthritis could be markedly decreased if early-stage arthritis could be routinely detected and classified by clinical chemistry test. We hypothesised that damage to proteins of the joint by oxidation, nitration and glycation, and with signatures released in plasma as oxidized, nitrated and glycated amino acids may facilitate early-stage diagnosis and typing of arthritis. Methods Patients with knee joint early-stage and advanced OA and RA or other inflammatory joint disease (non-RA) and healthy subjects with good skeletal health were recruited for the study (n = 225). Plasma/serum and synovial fluid was analysed for oxidized, nitrated and glycated proteins and amino acids by quantitative liquid chromatography-tandem mass spectrometry. Data-driven machine learning methods were employed to explore diagnostic utility of the measurements for detection and classifying early-stage OA and RA, non-RA and good skeletal health with training set and independent test set cohorts. Results Glycated, oxidized and nitrated proteins and amino acids were detected in synovial fluid and plasma of arthritic patients with characteristic patterns found in early and advanced OA and RA, and non-RA, with respect to healthy controls. In early-stage disease, two algorithms for consecutive use in diagnosis were developed: (1) disease versus healthy control, and (2) classification as OA, RA and non-RA. The algorithms featured 10 damaged amino acids in plasma, hydroxyproline and anti-CCP antibody status. Sensitivities/specificities were: (1) good skeletal health, 0.92/0.91; (2) early-stage OA, 0.92/0.90; early-stage RA, 0.80/0.78; and non-RA, 0.70/0.65 (training set). These were confirmed in independent test set validation. Damaged amino acids increased further in severe and advanced OA and RA. Conclusions Oxidized, nitrated and glycated amino acids combined with hydroxyproline and anti-CCP antibody status provided a plasma-based biochemical test of relatively high sensitivity and specificity for early-stage diagnosis and typing of arthritic disease. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1154-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Usman Ahmed
- Warwick Medical School, Clinical Sciences Research Laboratories, University of Warwick, University Hospital, Coventry, CV2 2DX, UK
| | - Attia Anwar
- Warwick Medical School, Clinical Sciences Research Laboratories, University of Warwick, University Hospital, Coventry, CV2 2DX, UK
| | - Richard S Savage
- Warwick Systems Biology Centre, Senate House, University of Warwick, Coventry, CV4 7AL, UK
| | - Paul J Thornalley
- Warwick Medical School, Clinical Sciences Research Laboratories, University of Warwick, University Hospital, Coventry, CV2 2DX, UK.,Warwick Systems Biology Centre, Senate House, University of Warwick, Coventry, CV4 7AL, UK
| | - Naila Rabbani
- Warwick Medical School, Clinical Sciences Research Laboratories, University of Warwick, University Hospital, Coventry, CV2 2DX, UK. .,Warwick Systems Biology Centre, Senate House, University of Warwick, Coventry, CV4 7AL, UK.
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Datta M, Savage P, Lovato J, Schwartz GG. Serum calcium, albumin and tumor stage in cutaneous malignant melanoma. Future Oncol 2016; 12:2205-14. [PMID: 27306120 PMCID: PMC5066137 DOI: 10.2217/fon-2016-0046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/24/2016] [Indexed: 01/05/2023] Open
Abstract
AIM Assess the relationship of serum calcium and serum albumin to tumor stage and other clinical characteristics in patients with cutaneous malignant melanoma (MM). PATIENTS & METHODS A cross-sectional study to evaluate serum calcium as a marker of disease progression (n = 644) in MM. RESULTS Serum albumin was significantly lower among men (p < 0.01) and among patients with stage 4 disease (p < 0.05). In a multivariable regression model adjusted for age, gender and site, albumin-corrected calcium was positively associated with disease stage (odds ratio: 1.46; 95% CI: 1.02-2.07; p = 0.04). The odds of higher stage increased 60% for each 1.0 mg/dl increase in albumin-corrected calcium. CONCLUSION Higher albumin-corrected serum calcium may be a marker of disease progression in MM.
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Affiliation(s)
| | - Paul Savage
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James Lovato
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gary G Schwartz
- University of North Dakota School of Medicine & Health Sciences, 501 N Columbia Rd Stop 9037, Grand Forks, ND 25202-9037, USA
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Shafiee E, Rezaee H, Entezari T, Hamishehkar H. The Evaluation of Albumin Use in an Iranian University Hospital. PHARMACEUTICAL SCIENCES 2016. [DOI: 10.15171/ps.2016.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Albumin Supplementation as a Therapeutic Strategy in Cardiac Surgery: Useful Tool or Expensive Hobby? Anesthesiology 2016; 124:983-5. [PMID: 26866530 DOI: 10.1097/aln.0000000000001052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim HJ, Koh WU, Kim SG, Park HS, Song JG, Ro YJ, Yang HS. Early postoperative albumin level following total knee arthroplasty is associated with acute kidney injury: A retrospective analysis of 1309 consecutive patients based on kidney disease improving global outcomes criteria. Medicine (Baltimore) 2016; 95:e4489. [PMID: 27495094 PMCID: PMC4979848 DOI: 10.1097/md.0000000000004489] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA.The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups according to the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). Multivariate logistic regression analysis was used to assess risk factors for AKI. A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023). After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA.
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Affiliation(s)
| | | | | | | | - Jun-Gol Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence: Jun-Gol Song, Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea (e-mail: )
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Abstract
Most doctors in Britain receive some training in the care of the burned patient, if not as an undergraduate then as part of training in accident and emergency medicine or in the Advanced Trauma Life Support (ATLS®) course. Because major burn injury presents infrequently to the average district hospital, most of this training is rusty by the time it is needed. Further, most have little opportunity to catch up with developments in this very specialized area of trauma medicine. This paper aims to address some of these shortcomings by describing recent advances in burn care and highlighting areas of current debate. The fluids used for resuscitation, improved options for treatment, the status of ongoing discussions about treatment facilities and the state of the art in managing smoke inhalation are reviewed. Some pointers to the future and to avenues for research are suggested.
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Affiliation(s)
- Keith Judkins
- Pinderfields Burn Centre, Pinderfields and Pontefract Hospitals NHS Trust, Wakefield, UK, ,
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118
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Abstract
In the absence of red blood cells or any other colloid, human albumin has saved thousands of lives since its first use in 1941. However, for general volume expansion purposes including trauma resuscitation, published evidence suggests that albumin has now been superseded by synthetic colloids, which are more effective volume expanders, have vascular protective effects and are cheaper.
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Abstract
For many years there has been a debate about whether crystalloids or colloids should be used for resuscitation. Some years ago, albumin was the gold standard against which all other solutions were compared. This continues to be the case, despite the fact that other solutions are as effective for volume replacement. This paper stresses the need for a proper understanding of the properties of solutions that may influence the choice for volume replacement. Different classes of solutions are discussed in detail, with special reference to their effects on cardiovascular and oxygen transport parameters. Other important properties such as side-effects and effect on coagulation are also considered.
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Abstract
The glyoxalase system in the cytoplasm of cells provides the primary defence against glycation by methylglyoxal catalysing its metabolism to D-lactate. Methylglyoxal is the precursor of the major quantitative advanced glycation endproducts in physiological systems - arginine-derived hydroimidazolones and deoxyguanosine-derived imidazopurinones. Glyoxalase 1 of the glyoxalase system was linked to anthropometric measurements of obesity in human subjects and to body weight in strains of mice. Recent conference reports described increased weight gain on high fat diet-fed mouse with lifelong deficiency of glyoxalase 1 deficiency, compared to wild-type controls, and decreased weight gain in glyoxalase 1-overexpressing transgenic mice, suggesting a functional role of glyoxalase 1 and dicarbonyl stress in obesity. Increased methylglyoxal, dicarbonyl stress, in white adipose tissue and liver may be a mediator of obesity and insulin resistance and thereby a risk factor for development of type 2 diabetes and non-alcoholic fatty liver disease. Increased methylglyoxal formation from glyceroneogenesis on adipose tissue and liver and decreased glyoxalase 1 activity in obesity likely drives dicarbonyl stress in white adipose tissue increasing the dicarbonyl proteome and related dysfunction. The clinical significance will likely emerge from on-going clinical evaluation of inducers of glyoxalase 1 expression in overweight and obese subjects. Increased transcapillary escape rate of albumin and increased total body interstitial fluid volume in obesity likely makes levels of glycation of plasma protein unreliable indicators of glycation status in obesity as there is a shift of albumin dwell time from plasma to interstitial fluid, which decreases overall glycation for a given glycemic exposure.
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Tanriverdi O, Avci N, Oktay E, Kalemci S, Pilanci KN, Cokmert S, Menekse S, Kocar M, Sen CA, Akman T, Ordu C, Goksel G, Meydan N, Barutca S. Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group. Asian Pac J Cancer Prev 2016; 16:5971-6. [PMID: 26320482 DOI: 10.7314/apjcp.2015.16.14.5971] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several prognostic factors have been studied in NSCLC, although it is unknown which is most useful. In this study, we aimed to investigate whether pre-treatment serum albumin level has prognostic value in patients with Stage IIIB NSCLC. MATERIALS AND METHODS This cross-sectional study included a total of 204 patients with Stage IIIB NSCLC who met the inclusion criteria. Pre-treatment serum albumin levels and demographic, clinical, and histological characteristics, as well as laboratory variables were recorded. A cut-off value was defined for serum albumin level and the patients were stratified into four groups on thios basis. RESULTS The majority of the patients was males and smokers, with a history of weight loss, and squamous histological type of lung cancer. The mean serum albumin level was 3.2±1.7 g/dL (range, 2.11-4.36 g/dL). A cut-off value 3.11 g/dL was set and among the patients with a lower level, 68% had adenocarcinoma and 82% were smokers. The patients with low serum albumin levels had a lower response rate to e first-line chemotherapy with a shorter progression-free survival and overall survival. Multivariate analysis showed that low serum albumin level was an independent poor prognostic factor for NSCLC. CONCLUSIONS This study results suggest that low serum albumin level is an independent poor prognostic factor in patients with Stage IIIB NSCLC, associated with reduction in the response rate to first-line therapy and survival rates.
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Affiliation(s)
- Ozgur Tanriverdi
- Department of Medical Oncology, Sitki Kocman University Faculty of Medicine, Mugla, Turkey E-mail :
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Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project. Int J Cardiol 2016; 219:20-4. [PMID: 27257851 DOI: 10.1016/j.ijcard.2016.05.067] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decreased serum albumin level (SAL) was reported to be associated with increased risk of cardiovascular events and short term-mortality in patients with acute myocardial infarction (AMI). OBJECTIVES To evaluate the association between SAL and long-term mortality in AMI hospital survivors. METHODS Retrospective analysis of patients admitted in a tertiary medical center for AMI 2002-2012 and discharged alive. EXCLUSION CRITERIA active infections, inflammatory diseases, significant liver or kidney failure, malignancy, ejection-fraction <20%, severe heart valvular-disease and missing SAL. SAL was categorized as following: <3.4, 3.4-3.7, 3.7-3.9, 3.9-4.1 and >4.1g/dL. The primary outcome was all-cause mortality for up-to 10-years post-AMI. RESULTS Out of 12,535 patients, 8750 were included. Patients with reduced SAL were older, higher rate of women, increased prevalence of severe left ventricular dysfunction, chronic renal failure, diabetes mellitus and ST-elevation AMI, 3-vessel coronary artery disease, and in-hospital complications. While the prevalence of chronic ischemic coronary disease, dyslipidemia, smokers and obesity, was lower. Mortality rates throughout the follow-up period increased as SAL decreased with 17.6%, 24%, 28.5%, 38.6%, and 57.5% for SAL of >4.1, 3.9-4.1, 3.7-3.9, 3.4-3.7 and <3.4g/dL respectively (p-for-trend <0.001). Using the SAL category of >4.1g/dL as the reference group, Adjusted Hazard Ratio values were 1.14 (p=0.107), 1.23 (p=0.007), 1.39 (p<0.001) and 1.70 (p<0.001) for the SAL categories of 3.9-4.1, 3.7-3.9, 3.4-3.7 and <3.4g/dL respectively. CONCLUSIONS Decreased SAL on admission, including levels within "normal" clinical range, is significantly associated with long-term all-cause mortality in hospital survivors of AMI with a "dose-response" type association.
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Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery with a Preoperative Albumin Level of Less Than 4.0 g/dl. Anesthesiology 2016; 124:1001-11. [DOI: 10.1097/aln.0000000000001051] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Hypoalbuminemia may increase the risk of acute kidney injury (AKI). The authors investigated whether the immediate preoperative administration of 20% albumin solution affects the incidence of AKI after off-pump coronary artery bypass surgery.
Methods
In this prospective, single-center, randomized, parallel-arm double-blind trial, 220 patients with preoperative serum albumin levels less than 4.0 g/dl were administered 100, 200, or 300 ml of 20% human albumin according to the preoperative serum albumin level (3.5 to 3.9, 3.0 to 3.4, or less than 3.0 g/dl, respectively) or with an equal volume of saline before surgery. The primary outcome measure was AKI incidence after surgery. Postoperative AKI was defined by maximal AKI Network criteria based on creatinine changes.
Results
Patient characteristics and perioperative data except urine output during surgery were similar between the two groups studied, the albumin group and the control group. Urine output (median [interquartile range]) during surgery was higher in the albumin group (550 ml [315 to 980]) than in the control group (370 ml [230 to 670]; P = 0.006). The incidence of postoperative AKI in the albumin group was lower than that in the control group (14 [13.7%] vs. 26 [25.7%]; P = 0.048). There were no significant between-group differences in severe AKI, including renal replacement therapy, 30-day mortality, and other clinical outcomes. There were no significant adverse events.
Conclusion
Administration of 20% exogenous albumin immediately before surgery increases urine output during surgery and reduces the risk of AKI after off-pump coronary artery bypass surgery in patients with a preoperative serum albumin level of less than 4.0 g/dl.
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Cross-Sectional Guidelines for Therapy with Blood Components and Plasma Derivatives: Chapter 5 Human Albumin - Revised. Transfus Med Hemother 2016; 43:223-32. [PMID: 27403094 PMCID: PMC4924448 DOI: 10.1159/000446043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 12/21/2022] Open
Abstract
Chapter 5 'Human Albumin' that was suspended on January 10, 2011 has been completed and updated in the present version.
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125
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Milevoj Kopčinović L, Domijan AM, Posavac K, Čepelak I, Žanić Grubišić T, Rumora L. Systemic redox imbalance in stable chronic obstructive pulmonary disease. Biomarkers 2016; 21:692-698. [PMID: 27121533 DOI: 10.3109/1354750x.2016.1172110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Increased oxidative burden is found in chronic obstructive pulmonary disease (COPD). OBJECTIVE To assess the association of ceruloplasmin, albumin, bilirubin, transferrin, thiols and malondialdehyde (MDA) with stable COPD. MATERIALS AND METHODS Oxidative stress markers measured in 106 COPD patients and 45 healthy subjects were evaluated. RESULTS Higher ceruloplasmin and MDA, and lower albumin, transferrin and thiols in COPD patients were found. Ceruloplasmin was the strongest single predictor of COPD. The model combining ceruloplasmin, albumin and thiols improved their individual diagnostic performances. CONCLUSIONS Diagnostic characteristics of ceruloplasmin, albumin, transferrin, thiols and MDA suggest their potential value as additional tools in disease diagnosis.
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Affiliation(s)
- Lara Milevoj Kopčinović
- a University Department of Chemistry, Medical School University Hospital Centre Sestre Milosrdnice , Zagreb , Croatia
| | - Ana-Marija Domijan
- b Department of Pharmaceutical Botany, Faculty of Pharmacy and Biochemistry , University of Zagreb , Zagreb , Croatia
| | - Ksenija Posavac
- c Department of Medical Biochemistry and Hematology , Faculty of Pharmacy and Biochemistry, University of Zagreb , Zagreb , Croatia
| | - Ivana Čepelak
- c Department of Medical Biochemistry and Hematology , Faculty of Pharmacy and Biochemistry, University of Zagreb , Zagreb , Croatia
| | - Tihana Žanić Grubišić
- c Department of Medical Biochemistry and Hematology , Faculty of Pharmacy and Biochemistry, University of Zagreb , Zagreb , Croatia
| | - Lada Rumora
- c Department of Medical Biochemistry and Hematology , Faculty of Pharmacy and Biochemistry, University of Zagreb , Zagreb , Croatia
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Fotopoulou C, Jones BP, Savvatis K, Campbell J, Kyrgiou M, Farthing A, Brett S, Roux R, Hall M, Rustin G, Gabra H, Jiao L, Stümpfle R. Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities. Arch Gynecol Obstet 2016; 294:607-14. [PMID: 27040418 DOI: 10.1007/s00404-016-4080-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center. METHODS/MATERIALS A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis. RESULTS We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19-91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100-540 min). Median surgical complexity score was 10 (range 5-15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % (n = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0-104) and 8 days (range 4-118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks. CONCLUSIONS Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future evaluations should include quality of life analyses.
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Affiliation(s)
- Christina Fotopoulou
- West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK. .,Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK.
| | - Benjamin P Jones
- West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK
| | | | - Jeremy Campbell
- Department of Anesthetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 OHS, UK
| | - Maria Kyrgiou
- West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK.,Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Alan Farthing
- West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK
| | - Stephen Brett
- Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK
| | - Rene Roux
- Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK
| | - Marcia Hall
- Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK
| | - Gordon Rustin
- Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK
| | - Hani Gabra
- West London Gynecological Cancer Centre, Imperial College NHS Trust, London, W12 OHS, UK.,Department of Surgery and Cancer and Ovarian Cancer Action Research Centre, Imperial College London, Du Cane Road, London, W12 0HS, UK
| | - Long Jiao
- Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, W12 0HS, UK
| | - Richard Stümpfle
- Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK
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Preoperative hypoalbuminemia is a risk factor for 30-day morbidity after gynecological malignancy surgery. Obstet Gynecol Sci 2015; 58:359-67. [PMID: 26430660 PMCID: PMC4588840 DOI: 10.5468/ogs.2015.58.5.359] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/03/2015] [Accepted: 01/06/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the relationship between preoperative hypoalbuminemia and the development of complications after gynecological cancer surgery, as well as postoperative bowel function and hospital stay. METHODS The medical records of 533 patients with gynecological cancer surgery at Konkuk University Hospital between 2005 and 2013 were reviewed. Serum albumin level <3.5 g/dL was defined as hypoalbuminemia. All perioperative complications within 30-days after surgery, time to resumption of normal diet and length of postoperative hospital stay, were analyzed. Regression models were used to assess predictors of postoperative morbidity. RESULTS The median age was 49 years (range, 13 to 85 years). Eighty patients (15%) had hypoalbuminemia. Hypoalbuminemic patients had significantly higher consumption of alcohol >2 standard drinks per day, lower American Society of Anesthesiologist score, higher frequency of ascites, and more advanced stage compared with non-hypoalbuminemic patients. Overall complication rate within 30-days after surgery was 20.3% (108 out of 533). Hypoalbuminemic patients were more likely to develop postoperative complications compared to non-hypoalbuminemic patients (34.3% vs. 17.8%, P=0.022), and had significantly longer median time to resumption of normal diet (3.3 [1-6] vs. 2.8 [0-15] days, P=0.005) and length of postoperative hospital stay (0 [7-50] vs. 9 [1-97] days, P=0.014). In multivariate analysis, age >50 (odds ratio [OR], 2.478; 95% confidence interval [CI], 1.310 to 4.686; P=0.005), operation time (OR, 1.006; 95% CI, 1.002 to 1.009; P=0.006), and hypoalbuminemia (OR, 2.367; 95% CI, 1.021 to 5.487; P=0.044) were the significant risk factor for postoperative complications. CONCLUSION Preoperative hypoalbuminemia in patients with elective surgery for gynecologic malignancy is an independent predictor of 30-days postoperative complications. Identification of this subset and preoperative optimization of nutritional status may improve surgical outcomes.
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128
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Ji L, Su X, Qin W, Mi X, Liu F, Tang X, Li Z, Yang L. Novel risk score of contrast-induced nephropathy after percutaneous coronary intervention. Nephrology (Carlton) 2015; 20:544-51. [PMID: 25706048 DOI: 10.1111/nep.12429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Ling Ji
- West China Medical School of Sichuan University; Chengdu China
| | - XiaoFeng Su
- West China Medical School of Sichuan University; Chengdu China
| | - Wei Qin
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - XuHua Mi
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Fei Liu
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - XiaoHong Tang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Zi Li
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - LiChuan Yang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
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129
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Vlaardingerbroek H, Schierbeek H, Rook D, Vermeulen MJ, Dorst K, Vermes A, van Goudoever JB, van den Akker CHP. Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration. Clin Nutr 2015; 35:344-350. [PMID: 26028361 DOI: 10.1016/j.clnu.2015.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 04/04/2015] [Accepted: 04/29/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND & AIMS Albumin is one of the most important plasma proteins and plays a key role in many physiologic processes, such as preserving colloid osmotic pressure, scavenging radicals, and binding and transporting bilirubin, hormones, and drugs. However, albumin concentrations are often low in preterm infants during the first days of life. We hypothesized that early parenteral lipid and high-dose amino acid (AA) administration to very low birth weight (VLBW) infants from birth onwards increases hepatic albumin synthesis rates. METHODS Inborn VLBW infants were randomized to receive from birth onwards either 2.4 g amino acids/(kg(·)d) (control group), 2.4 g amino acids/(kg(·)d) plus 2 g lipids/(kg(·)d) (AA + lipid group), or 3.6 g amino acids/(kg(·)d) plus 2 g lipids/(kg(·)d) (high AA + lipid group). On postnatal day 2, infants received a primed continuous infusion of [U-(13)C6,(15)N]leucine. Mass spectrometry was used to determine the fractional and absolute albumin synthesis rates (FSR and ASR, respectively). RESULTS In total, 28 infants (median gestational age 27 weeks (IQR 25-28), median birth weight 810 g (IQR 679-998) were studied. The median FSR was 6.5%/d in the control group, 10.6%/d in the AA group, and 12.3%/d in the high AA + lipid group, while the median was 84 mg/(kg(·)d) in the control group, 138 mg/(kg(·)d) in the AA group, and 160 mg/(kg(·)d) in the high AA + lipid group. CONCLUSION A group of VLBW infants given parenteral nutrition containing lipids and high-dose amino acids showed a higher rate of albumin synthesis compared to infants receiving no lipids and standard amounts of amino acids during the first two days of life.
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Affiliation(s)
- Hester Vlaardingerbroek
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Henk Schierbeek
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital - AMC, c/o Room H7-282, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Denise Rook
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Kristien Dorst
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Andras Vermes
- Hospital Pharmacy, Erasmus MC, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital - AMC, c/o Room H7-282, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Department of Pediatrics, VU University Medical Center, c/o Room ZH 9D11, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Chris H P van den Akker
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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130
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Bueno-Sánchez JC, Peña-Alzate S, Peña RB, Agudelo-Jaramillo B, Cadavid-Jaramillo AP, Chaouat G, Maldonado-Estrada JG. Sera from early-onset, severely preeclamptic women directly modulate HLA-E expression in the EA.hy296 endothelial cell line. J Reprod Immunol 2014; 104-105:68-79. [PMID: 24837231 DOI: 10.1016/j.jri.2014.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 11/18/2022]
Abstract
The expression of endothelial HLA-E in the context of the systemic inflammatory response observed in preeclampsia has not been established. An experimental study was designed to determine the effect of the sera of pregnant women on the expression of HLA-E in EA.hy296 endothelial cells. First, measurements of protein fractions were performed in sera from early-onset, severely preeclamptic women without HELLP syndrome, in which there was no significant difference in total proteins between the groups, but a reduced level of plasma albumin and an increase in α1-globulin were observed in both groups of pregnant women compared with non-pregnant women. Measurements of colloid osmotic pressure (COP) using a recalculated albumin/globulin ratio formula determined only a significant decrease in COP in all pregnant groups compared with non-pregnant women. The expression of membrane HLA-E was increased in EA.hy296 endothelial cells stimulated with sera of early-onset, severely preeclamptic women, while recombinant interferon-γ (IFN-γ) significantly reduced the expression of membrane HLA-E. Pro-inflammatory cytokines were measured by Luminex in the serum samples, and increased levels of tumor necrosis factor (TNF) and decreased levels of IFN-γ were observed in early-onset, severe preeclampsia compared with normal pregnancy. Moreover, soluble HLA-E was detected in these serum samples by Western blot and ELISA, but no significant difference was found. This raises the possibility that a systemic inflammatory response promotes a compensatory mechanism of COP balance in severe preeclampsia by release of inflammation-induced factors, including endothelial HLA-E. Evidence is now provided regarding HLA-E expression by EA.hy296 cells.
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Affiliation(s)
- J C Bueno-Sánchez
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia; Department of Physiology and Biochemistry, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia.
| | - S Peña-Alzate
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
| | - R B Peña
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
| | - B Agudelo-Jaramillo
- NACER-SSR, Department of Obstetrics and Gynaecology, School of Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia; Hospital Universitario San Vicente Fundación and Hospital General de Medellín, Obstetrics and Gynaecology Services, Medellín, Colombia
| | - A P Cadavid-Jaramillo
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
| | - G Chaouat
- INSERM U 976, Pavillon Bazin, Hopital Saint Louis, 75010 Paris, France
| | - J G Maldonado-Estrada
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia; Centauro Group, School of Veterinary Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
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131
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Chronic spontaneous urticaria is characterized by lower serum advanced glycation end-products. BIOMED RESEARCH INTERNATIONAL 2014; 2014:974154. [PMID: 25180195 PMCID: PMC4144150 DOI: 10.1155/2014/974154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 01/18/2023]
Abstract
Background. Chronic spontaneous urticaria (CSU) is associated with activation of acute phase response. On the other hand, it is known that systemic inflammation may lead to increased formation of advanced glycation end-products (AGEs), associated with pathogenesis of various diseases. Aim. We aim to test whether chronic inflammation manifested by activated acute phase response may provide a mechanism for increased serum AGEs concentration in CSU. Methods. Concentrations of AGEs were measured spectrofluorimetrically in serum of CSU patients and the healthy subjects. Results. Serum AGEs and albumin concentrations in CSU patients were significantly lower as compared with the healthy subjects. Serum CRP concentration was significantly higher in patients with CSU than in the controls. Significant positive correlation was observed between AGEs and albumin concentrations in the subjects. Conclusions. CSU is not associated with increased circulating AGEs concentrations, despite the enhanced systemic inflammatory response. Paradoxical decrease of serum AGEs concentrations is probably a reflection of lower concentration of “negative acute phase proteins” such as albumin.
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Liong S, Di Quinzio MKW, Fleming G, Permezel M, Rice GE, Georgiou HM. New biomarkers for the prediction of spontaneous preterm labour in symptomatic pregnant women: a comparison with fetal fibronectin. BJOG 2014; 122:370-9. [DOI: 10.1111/1471-0528.12993] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 01/07/2023]
Affiliation(s)
- S Liong
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Vic. Australia
- Mercy Perinatal Research Centre; Mercy Hospital for Women; Heidelberg Vic. Australia
| | - MKW Di Quinzio
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Vic. Australia
- Mercy Perinatal Research Centre; Mercy Hospital for Women; Heidelberg Vic. Australia
| | - G Fleming
- Mercy Perinatal Research Centre; Mercy Hospital for Women; Heidelberg Vic. Australia
| | - M Permezel
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Vic. Australia
- Mercy Perinatal Research Centre; Mercy Hospital for Women; Heidelberg Vic. Australia
| | - GE Rice
- Centre for Clinical Research; Royal Brisbane and Women's Hospital; University of Queensland; Herston Qld Australia
| | - HM Georgiou
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Vic. Australia
- Mercy Perinatal Research Centre; Mercy Hospital for Women; Heidelberg Vic. Australia
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Vincent JL, Russell JA, Jacob M, Martin G, Guidet B, Wernerman J, Ferrer R, Roca RF, McCluskey SA, Gattinoni L. Albumin administration in the acutely ill: what is new and where next? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:231. [PMID: 25042164 PMCID: PMC4223404 DOI: 10.1186/cc13991] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Albumin solutions have been used worldwide for the treatment of critically ill patients since they became commercially available in the 1940s. However, their use has become the subject of criticism and debate in more recent years. Importantly, all fluid solutions have potential benefits and drawbacks. Large multicenter randomized studies have provided valuable data regarding the safety of albumin solutions, and have begun to clarify which groups of patients are most likely to benefit from their use. However, many questions remain related to where exactly albumin fits within our fluid choices. Here, we briefly summarize some of the physiology and history of albumin use in intensive care before offering some evidence-based guidance for albumin use in critically ill patients.
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134
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Lee EH, Kim HR, Baek SH, Kim KM, Chin JH, Choi DK, Kim WJ, Choi IC. Risk factors of postoperative acute kidney injury in patients undergoing esophageal cancer surgery. J Cardiothorac Vasc Anesth 2014; 28:936-42. [PMID: 24680132 DOI: 10.1053/j.jvca.2013.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify perioperative risk factors for postoperative acute kidney injury (AKI) in patients undergoing esophageal cancer surgery. DESIGN A retrospective analysis of the prospectively collected medical data. SETTING A tertiary care university hospital. PARTICIPANTS All consecutive adult patients (n=595) who underwent elective esophageal surgery for cancer between January 2005 and April 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS AKI was defined by the AKI Network criteria based on serum creatinine changes within the first 48 hours after esophageal cancer surgery. The relationship between perioperative variables and AKI was evaluated using multivariate logistic regression. Postoperative AKI developed in 210 (35.3%) patients. Risk factors for AKI were body mass index (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.14), preoperative serum albumin level (OR 0.52; 95% CI 0.33-0.84), use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (OR 1.35; 95% CI 1.05-1.75), colloid infusion during surgery (OR 1.11; 95% CI 1.06-1.18), and postoperative 2-day C-reactive protein (OR 1.05; 95% CI 1.01-1.09). Postoperative AKI was associated with prolonged length of hospital stay. CONCLUSIONS Postoperative AKI is common in patients undergoing esophageal surgery for cancer. Closer evaluation and monitoring in patients with risk factors for AKI may be warranted.
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Affiliation(s)
- Eun-Ho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Hee Baek
- Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Mi Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Kee Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook-Jong Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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135
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Smith SE, Williams JM, Ando S, Koide K. Time-insensitive fluorescent sensor for human serum albumin and its unusual red shift. Anal Chem 2014; 86:2332-6. [PMID: 24527887 PMCID: PMC3983026 DOI: 10.1021/ac5001256] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The concentration of human serum albumin (HSA) indicates the health state of individuals and is routinely measured by UV spectroscopy with bromocresol. However, this method tends to overestimate HSA, and more critically, depends highly on the timing, in seconds, of the measurements. Here, we report an analog of 2',7'-dichlorofluorescein that can be used as a fluorescent sensor to quantify HSA in human sera. The accuracy of this new method proved superior to that of bromocresol when an international standard serum sample was analyzed. This method is more convenient than the bromocresol method because it allows for fluorescence measurements during a >15 min period. Colorimetric analysis was also performed to further investigate the effects of the binding of the sensor to HSA. These spectroscopic studies suggest that absorption and emission changes upon HSA binding may be due to the dehydration of the dye and/or stabilization of the tritylic cation species.
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Affiliation(s)
- Sara E Smith
- Department of Chemistry, University of Pittsburgh , 219 Parkman Avenue, Pittsburgh, Pennsylvania 15260, United States
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136
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Zhou T, Lu S, Liu X, Zhang Y, Xu F. Review of the rational use and adverse reactions to human serum albumin in the People's Republic of China. Patient Prefer Adherence 2013; 7:1207-12. [PMID: 24348023 PMCID: PMC3849079 DOI: 10.2147/ppa.s53484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Human serum albumin (HSA) is an ideal natural colloid that has been widely used in clinical practice for supplemental albumin or as a plasma substitute during therapeutic plasma exchanges to redress hypoproteinemia. However, a paucity of well-designed clinical trials, a lack of a clear cut survival benefit, and frequent case reports of adverse drug reaction (ADR) make the use of HSA controversial. This study aims to review and to comment on the reported ADRs of HSA in the People's Republic of China, so as to provide the basis for rational HSA use in clinical settings. Data on the ADR case reports from HSA administration between January 1990 and December 2012 available from the China National Knowledge Infrastructure (CNKI) database, Wanfang data (WF), and Chinese Biomedical Literature (CBM) were reviewed. The reasons for using HSA, the types of ADRs, the causality of ADRs and the rationality for HSA administration were extracted and analyzed. In total, 61 cases of ADR reports were identified of which the primary disease of patients using HSA was malignant tumor (34.42%). The primary ADR was anaphylaxis (59.02%). Of the 61 cases, 30 were caused by irrational use of HSA. The most common irrational use was off-label use (56.67%), followed by inappropriate infusion rate. Therefore, we conclude that to avoid the occurrence of ADRs, guidelines for using HSA are needed to guarantee its rational use and HSA should be used strictly according to these guidelines. In addition, medical staff, including clinical pharmacists and nurses, should pay more attention to the patients who inject HSA to ensure its safe use in the clinic.
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Affiliation(s)
- Ting Zhou
- Department of Clinical Pharmacology, Fengxian Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Saihua Lu
- Department of Clinical Pharmacology, Fengxian Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Xiufeng Liu
- Department of Clinical Pharmacology, Fengxian Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Ye Zhang
- Department of Clinical Pharmacology, Fengxian Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Feng Xu
- Department of Clinical Pharmacology, Fengxian Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Correspondence: Feng Xu, Department of Clinical Pharmacology, Fengxian Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China, Tel +86 021 5742 2032, Email
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137
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Taguchi K, Jono H, Kugimiya-Taguchi T, Nagao S, Su Y, Yamasaki K, Mizuguchi M, Maruyama T, Ando Y, Otagiri M. Effect of albumin on transthyretin and amyloidogenic transthyretin Val30Met disposition and tissue deposition in familial amyloidotic polyneuropathy. Life Sci 2013; 93:1017-22. [PMID: 24211615 DOI: 10.1016/j.lfs.2013.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/03/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
AIMS Transthyretin (TTR)-related familial amyloidotic polyneuropathy (FAP) is characterized by the systemic accumulation of amyloid fibrils caused by amyloidogenic. Our previous studies demonstrated that albumin played a role in the inhibition of TTR amyloid-formation. The aim of this study was to evaluate the effect of albumin on TTR disposition and tissue deposition in vivo. MAIN METHODS For pharmacokinetic studies, recombinant wild-type TTR (rTTR) and recombinant amyloidogenic TTR Val30Met (rATTR V30M) were labeled with iodine and administered to Sprague-Dawley rats and analbuminemia rats (NAR: Nagase Analbuminemia Rats). The deposition of ATTR V30M was also analyzed by immunohistochemistry in the transgenic (Tg) rats possessing a human ATTR V30M gene (ATTR V30M Tg rats) and NAR possessing a human ATTR V30M gene (ATTR V30M Tg NAR). KEY FINDINGS The presence of albumin had no effect on the tissue distribution of either rTTR or rATTR V30M. However, more ATTR V30M was deposited in the hearts, stomachs and small intestines of ATTR V30M Tg NAR rats, compared to ATTR V30M Tg rats. SIGNIFICANCE Although the disposition of TTR and ATTR V30M was unaffected by the presence of albumin, the deposition of ATTR V30M in some organs was apparently increased in the absence of albumin compared to the presence of albumin. These results show that albumin would contribute to suppressing the tissue deposition of TTR in pathogenesis of FAP, but does not affect the disposition of TTR.
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Affiliation(s)
- Kazuaki Taguchi
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan; Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
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138
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Seebacher V, Grimm C, Reinthaller A, Heinze G, Tempfer C, Hefler L, Polterauer S. The value of serum albumin as a novel independent marker for prognosis in patients with endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2013; 171:101-6. [DOI: 10.1016/j.ejogrb.2013.07.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/02/2013] [Accepted: 07/31/2013] [Indexed: 11/25/2022]
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139
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Peroxynitrite induced structural changes result in the generation of neo-epitopes on human serum albumin. Int J Biol Macromol 2013; 59:349-56. [DOI: 10.1016/j.ijbiomac.2013.04.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 11/23/2022]
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140
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Serra R, Grande R, Buffone G, Gallelli L, Caroleo S, Tropea F, Amantea B, de Franciscis S. Albumin administration prevents the onset of pressure ulcers in intensive care unit patients. Int Wound J 2013; 12:432-5. [PMID: 23848184 DOI: 10.1111/iwj.12131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/14/2013] [Indexed: 11/28/2022] Open
Abstract
Pressure ulcers (PUs) are a common problem in critically ill patients admitted to the intensive care units (ICUs) and they account for more than 70% of patients with low serum albumin at admission. The aim of this study was to test the efficacy of intravenous administration of albumin in patients with low serum albumin < 3·3 g/dl. In a 1-year period, a total of 73 patients were admitted to the ICU (males 45, 61·64% and females 28, 38·36%); of these, 21 patients were admitted with hypoalbuminaemia (serum albumin < 3·3 g/dl) and randomised into two groups: 11 patients were treated with 25 g intravenous albumin for the first 3 days within the first week of ICU stay (group A) and 10 patients did not receive albumin (group B). Three patients (27·27%) showed the onset of PUs in group A, whereas seven patients (70%) showed the onset of PUs within the first 7 days of stay in group B. Moreover, ulcers of group B were more severe than those of group A. This study shows that intravenous administration of albumin reduces the onset of PUs in patients admitted to the ICU and in some cases it also reduces the risk of progression to advanced stages of PUs.
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Affiliation(s)
- Raffaele Serra
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Grande
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Gianluca Buffone
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Santo Caroleo
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Tropea
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Bruno Amantea
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
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142
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Verbeek L, Slaghekke F, Hulzebos C, Oepkes D, Walther F, Lopriore E. Hypoalbuminemia in Donors with Twin Anemia-Polycythemia Sequence: A Matched Case-Control Study. Fetal Diagn Ther 2013; 33:241-5. [DOI: 10.1159/000345716] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/05/2012] [Indexed: 11/19/2022]
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143
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Verbeek L, Middeldorp J, Hulzebos C, Oepkes D, Walther F, Lopriore E. Hypoalbuminemia in Donors with Twin-Twin Transfusion Syndrome. Fetal Diagn Ther 2013. [DOI: 10.1159/000345086] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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144
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Zhang Z, Lu B, Ni H, Sheng X, Jin N. Prediction of pulmonary edema by plasma protein levels in patients with sepsis. J Crit Care 2012; 27:623-9. [PMID: 23089680 DOI: 10.1016/j.jcrc.2012.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/06/2012] [Accepted: 08/13/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE The difficulties of fluid therapy in patients with septic shock are to maintain sufficient vascular volume while preventing pulmonary edema formation. Thus, it is important to find a biomarker that can reliably predict pulmonary edema formation after fluid loading. We evaluated the association of plasma protein levels with the increase in extravascular lung water index (ΔEVLWI) after fluid loading. METHODS This was an observational study in which we retrospectively reviewed medical records of septic patients in whom hemodynamic variables were measured by transpulmonary thermodilution technique before and after fluid loading. Plasma protein levels were measured before fluid loading. Patients were divided into 2 groups according to the changes in EVLWI (ΔEVLWI ≥ 10%) after fluid loading. Diagnostic performance of plasma proteins in predicting pulmonary edema formation was assessed. RESULTS A total of 62 patients were included, and 27 of them showed a ΔEVLWI 10% or higher after fluid loading. Plasma albumin and transferrin were significantly lower in this group than in the group with ΔEVLWI less than 10% (21.7 ± 5.8 vs 25.3 ± 5.0 g/L for albumin, P < .05; 107.9 ± 50.1 vs 136.8 ± 44.2 mg/dL for transferrin, P < .05). Areas under the curve of albumin and transferrin were 0.68 (cardiac index, 0.54-0.83) and 0.72 (cardiac index, 0.59-0.86), respectively. At a cutoff value of 87.9 mg/dL, transferrin had a sensitivity of 0.91 in predicting ΔEVLWI 10% or higher. CONCLUSIONS Plasma transferrin and albumin levels were associated with ΔEVLWI 10% or higher after fluid loading. The high sensitivity of both biomarkers indicated that patients with normal values were less likely to develop pulmonary edema after fluid loading.
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Affiliation(s)
- Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Zhejiang, People's Republic of China.
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145
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Assessment of Liver Stiffness Measurement: Novel Intraoperative Blood Loss Predictor? World J Surg 2012; 37:185-91. [DOI: 10.1007/s00268-012-1774-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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146
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147
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Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med 2012; 38:1478-86. [PMID: 22618092 DOI: 10.1007/s00134-012-2599-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 04/25/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the association between preoperative low serum albumin level and acute kidney injury (AKI) after off-pump coronary artery bypass surgery (OPCAB) METHOD: We assessed preoperative and perioperative risk factors, and preoperative serum albumin concentration in 1,182 consecutive adult patients with preoperative normal renal function who underwent OPCAB surgery. Each patient was categorized by maximal Acute Kidney Injury Network (AKIN) criteria based on creatinine changes within the first 48 h after OPCAB. Logistic regression and propensity analyses were performed to evaluate the association between preoperative low serum albumin level and postoperative AKI. RESULTS Of the 1,182 patients, 334 (28.3%) developed AKI. Risk factors for AKI were old age, diabetes mellitus, maximal cardiovascular component of the sequential organ failure assessment score, perioperative transfusion, and postoperative C-reactive protein concentration. The risk of AKI was negatively correlated with the volume of crystalloid infused during surgery. A preoperative serum albumin level of <4.0 g/dl was independently associated Ith postoperative AKI [multivariable logistic analysis: odds ratio (OR) 1.83, 95 % confidence interval (CI) 1.27-2.64; P = 0.001; propensity analysis: OR 1.62, 95 % CI 1.12-2.35; P = 0.011). AKI was associated with prolonged stay in the intensive care unit and hospital and a high mortality rate. CONCLUSIONS Preoperative low serum albumin level is an independent risk factor for AKI, and postoperative AKI is associated with poor outcomes after OPCAB in patients with preoperative normal renal function.
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148
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Omron EM, Omron RM. A physicochemical model of crystalloid infusion on acid-base status. J Intensive Care Med 2012; 25:271-80. [PMID: 20622258 DOI: 10.1177/0885066610371633] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective of this study is to develop a physicochemical model of the projected change in standard base excess (SBE) consequent to the infused volume of crystalloid solutions in common use. A clinical simulation of modeled acid-base and fluid compartment parameters was conducted in a 70-kg test participant at standard physiologic state: pH =7.40, partial pressure of carbon dioxide (PCO2) = 40 mm Hg, Henderson-Hasselbalch actual bicarbonate ([HCO3]HH) = 24.5 mEq/L, strong ion difference (SID) = 38.9 mEq/L, albumin = 4.40 g/dL, inorganic phosphate = 1.16 mmol/L, citrate total = 0.135 mmol/L, and SBE =0.1 mEq/L. Simulations of multiple, sequential crystalloid infusions up to 10 L were conducted of normal saline (SID = 0), lactated Ringer's (SID = 28), plasmalyte 148 (SID = 50), one-half normal saline þ 75 mEq/L sodium bicarbonate (NaHCO3; SID = 75), 0.15 mol/L NaHCO3 (SID = 150), and a hypothetical crystalloid solution whose SID = 24.5 mEq/L, respectively. Simulations were based on theoretical completion of steady-state equilibrium and PCO2 was fixed at 40 mm Hg to assess nonrespiratory acid-base effects. A crystalloid SID equivalent to standard state actual bicarbonate (24.5 mEq/L) results in a neutral metabolic acid-base status for infusions up to 10 L. The 5 study solutions exhibited curvilinear relationships between SBE and crystalloid infusion volume in liters. Solutions whose SID was greater than 24.5 mEq/L demonstrated a progressive metabolic alkalosis and less, a progressive metabolic acidosis. In a human model system, the effects of crystalloid infusion on SBE are a function of the crystalloid and plasma SID, volume infused, and nonvolatile plasma weak acid changes. A projection of the impact of a unit volume of various isotonic crystalloid solutions on SBE is presented. The model's validation, applications, and limitations are examined.
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149
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Human serum albumin: from bench to bedside. Mol Aspects Med 2011; 33:209-90. [PMID: 22230555 DOI: 10.1016/j.mam.2011.12.002] [Citation(s) in RCA: 1186] [Impact Index Per Article: 91.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/21/2011] [Indexed: 02/07/2023]
Abstract
Human serum albumin (HSA), the most abundant protein in plasma, is a monomeric multi-domain macromolecule, representing the main determinant of plasma oncotic pressure and the main modulator of fluid distribution between body compartments. HSA displays an extraordinary ligand binding capacity, providing a depot and carrier for many endogenous and exogenous compounds. Indeed, HSA represents the main carrier for fatty acids, affects pharmacokinetics of many drugs, provides the metabolic modification of some ligands, renders potential toxins harmless, accounts for most of the anti-oxidant capacity of human plasma, and displays (pseudo-)enzymatic properties. HSA is a valuable biomarker of many diseases, including cancer, rheumatoid arthritis, ischemia, post-menopausal obesity, severe acute graft-versus-host disease, and diseases that need monitoring of the glycemic control. Moreover, HSA is widely used clinically to treat several diseases, including hypovolemia, shock, burns, surgical blood loss, trauma, hemorrhage, cardiopulmonary bypass, acute respiratory distress syndrome, hemodialysis, acute liver failure, chronic liver disease, nutrition support, resuscitation, and hypoalbuminemia. Recently, biotechnological applications of HSA, including implantable biomaterials, surgical adhesives and sealants, biochromatography, ligand trapping, and fusion proteins, have been reported. Here, genetic, biochemical, biomedical, and biotechnological aspects of HSA are reviewed.
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Neel DR, McClave S, Martindale R. Hypoalbuminaemia in the perioperative period: clinical significance and management options. Best Pract Res Clin Anaesthesiol 2011; 25:395-400. [PMID: 21925404 DOI: 10.1016/j.bpa.2011.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 07/12/2011] [Indexed: 12/15/2022]
Abstract
Albumin has been the focus of literally thousands of articles since its first use in the clinical setting during World War II. Despite being at the centre of several clinical controversies, many questions still remain regarding the use and abuse of albumin. The major physiologic functions include maintaining colloid osmotic pressure, binding and transport of metabolically active molecules, serving as an antioxidant, use as a surrogate marker of nutritional status and predictor of outcome in elective surgical populations, having an anti-thrombotic influence on platelets, aiding in acid-base balance and having a protective influence on capillary membrane integrity. Albumin will continue to be widely used in clinical medicine despite many of the drawbacks. It now appears the benefits in the use of albumin in most cases outweigh the risks. The clinical implications of hypoalbuminaemia as an indicator of surgical or intensive care unit (ICU) outcome or nutritional status is clearly disease- and organ specific. The use of albumin as a volume expander appears to have limited, if any, benefit over crystalloid. The "secondary" benefits of albumin in specific surgical and intensive-care conditions, such as sepsis and organ dysfunction, are numerous and are well supported in the current literature.
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Affiliation(s)
- Dustin R Neel
- Division of General Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L223A, Portland, OR 97239, USA
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