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Liu Y, Jiang J, Yuan H, Wang L, Song W, Pei F, Si X, Miao S, Chen M, Gu B, Guan X, Wu J. Dynamic increase in myoglobin level is associated with poor prognosis in critically ill patients: a retrospective cohort study. Front Med (Lausanne) 2024; 10:1337403. [PMID: 38264034 PMCID: PMC10804859 DOI: 10.3389/fmed.2023.1337403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
Background Myoglobin is an important biomarker for monitoring critically ill patients. However, the relationship between its dynamic changes and prognosis remains unclear. Methods We retrospectively enrolled 11,218 critically ill patients from a general and surgical intensive care unit (ICU) of a tertiary hospital between June 2016 and May 2020. Patients with acute cardiovascular events, cardiac and major vascular surgeries, and rhabdomyolysis were excluded. To investigate the early myoglobin distribution, the critically ill patients were stratified according to the highest myoglobin level within 48 h after ICU admission. Based on this, the critically ill patients with more than three measurements within 1 week after ICU admission were included, and latent class trajectory modeling was used to classify the patients. The characteristics and outcomes were compared among groups. Sensitivity analysis was performed to exclude patients who had died within 72 h after ICU admission. Restricted mean survival time regression model based on pseudo values was used to determine the 28-day relative changes in survival time among latent classes. The primary outcome was evaluated with comparison of in-hospital mortality among each Trajectory group, and the secondary outcome was 28-day mortality. Results Of 6,872 critically ill patients, 3,886 (56.5%) had an elevated myoglobin level (≥150 ng/mL) at admission to ICU, and the in-hospital mortality significantly increased when myoglobin level exceeded 1,000 μg/mL. In LCTM, 2,448 patients were unsupervisedly divided into four groups, including the steady group (n = 1,606, 65.6%), the gradually decreasing group (n = 523, 21.4%), the slowly rising group (n = 272, 11.1%), and the rapidly rising group (n = 47, 1.9%). The rapidly rising group had the largest proportion of sepsis (59.6%), the highest median Sequential Organ Failure Assessment (SOFA) score (10), and the highest in-hospital mortality (74.5%). Sensitivity analysis confirmed that 98.2% of the patients were classified into the same group as in the original model. Compared with the steady group, the rapidly rising group and the slowly rising group were significantly related to the reduction in 28-day survival time (β = -12.08; 95% CI -15.30 to -8.86; β = -4.25, 95% CI -5.54 to -2.97, respectively). Conclusion Elevated myoglobin level is common in critically ill patients admitted to the ICU. Dynamic monitoring of myoglobin levels offers benefit for the prognosis assessment of critically ill patients.
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Affiliation(s)
- Yishan Liu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Jinlong Jiang
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Hao Yuan
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Luhao Wang
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Wenliang Song
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Fei Pei
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Xiang Si
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Shumin Miao
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Minying Chen
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Bin Gu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
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Adibi A, Maleki S, Adibi P, Etminani R, Hovsepian S. Prevalence of Nonalcoholic Fatty Liver Disease and its Related Metabolic Risk Factors in Isfahan, Iran. Adv Biomed Res 2017; 6:47. [PMID: 28503502 PMCID: PMC5414408 DOI: 10.4103/2277-9175.204590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: This study aimed to determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and its related risk factors among the general population of Isfahan city located in the central part of Iran. Materials and Methods: In this cross-sectional study, the prevalence of NAFLD among 483 general adult populations was determined using ultrasonography. Anthropometric and biochemical variables were compared in groups with and without NAFLD and their predictive value for occurrence of NAFLD was investigated also. Results: Prevalence of NAFLD was 39.3%. Frequency of focal fatty infiltration (FFI), Grade I, Grade II, and Grade III of NAFLD was 9.5%, 21.1%, 7.2%, 1.4%, respectively. Prevalence of different types of NAFLD and FFI, was not different between female and male participants (P = 0.238). Ordinal regression was determined that all of the studied variables have significant predictive value for NAFLD (P < 0.001, γ = 0.615). Spearman correlation indicated that there was a significant relationship between NAFLD and BMI (r = 0.37, P < 0.001), age (r = 0.15, P = 0.001), FBS (r = 0.20, P < 0.001), cholesterol (r = 0.19, P < 0.001), triglyceride (r = 0.20, P < 0.001), LDL (r = 0.16, P < 0.001), AST (r = 0.17, P < 0.001), and ALT (r = 0.31, P < 0.001). Conclusions: Considering the high prevalence of NAFLD specially its lower grades among Isfahani adult general population and their association with studied variables, it seems that interventional studies which target-related mentioned risk factors could reduce the overall occurrence of NAFLD.
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Affiliation(s)
- Atoosa Adibi
- Department of Radiology, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahab Maleki
- Department of Radiology, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Department of Gastroenterology, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Etminani
- Department of Nutrition and Dietetics, School of Healthcare Sciences, National University of Malaysia, Selangor, Malaysia
| | - Silva Hovsepian
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Abangah G, Yousefi A, Asadollahi R, Veisani Y, Rahimifar P, Alizadeh S. Correlation of Body Mass Index and Serum Parameters With Ultrasonographic Grade of Fatty Change in Non-alcoholic Fatty Liver Disease. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12669. [PMID: 24719704 PMCID: PMC3964422 DOI: 10.5812/ircmj.12669] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 08/31/2013] [Accepted: 06/29/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a common liver disease in the western population and expanding disease in the world. Pathological changes in fatty liver are like alcohol liver damage, which can lead to end-stage liver disease. The prevalence of NAFLD in obese or overweight people is higher than general population, and it seems that people with high Body Mass Index (BMI) or abnormality in some laboratory tests are more susceptible for severe fatty liver and high grade of NAFLD in ultrasonography (U.S). OBJECTIVES This study aimed to evaluate the correlation of BMI and laboratory tests with NAFLD in ultrasonography. MATERIALS AND METHODS During a multi-step process, we selected two-hundred and thirteen cases from four hundred and eighteen patients with NAFLD. Laboratory tests performed included: ALT, AST, FBS, Triglyceride and cholesterol levels, hepatitis B surface antigen, hepatitis C antibody, ceruloplasmin, serum iron, TIBC, transferrin saturation, ferritin, AMA, ANA, ANTI LKM1, serum protein electrophoresis, TSH, anti TTG (IgA). BMI and ultrasonography for 213 patients were performed, and then data was analyzed. These parameters and grades of ultrasonography were compared with the values obtained using one way ANOVA. An ordinal logistic regression model was used to estimate the probability of ultrasonography grade. The Statistical Package for the Social Science program (SPSS, version 16.0) was used for data analysis. RESULTS Two-hundred and thirteen cases including 140 male and 73 female, were studied. In general, 72.3% of patients were overweight and obese. Post-hoc tests showed that only BMI (P < 0.001) and TG (P < 0.011) among variables had statistically significant associations with ultrasonography grade (USG), and ordinal logistic regression model showed that BMI and AST were the best predictors. DISCUSSION Our results suggest that in patients with NAFLD, BMI and TG are most effective factors in severity of fatty liver disease and ultrasonography grade (USG). On the other hand, BMI as a predictor can be helpful. But, AST has not been a reliable finding, because it changes in many conditions.
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Affiliation(s)
- Ghobad Abangah
- Department of Gastroenterology and Hepatology, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Atefeh Yousefi
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
| | | | - Yousef Veisani
- Department of Clinical Epidemiology, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Paria Rahimifar
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Sajjad Alizadeh
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
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Non-Alcoholic Fatty Liver Disease: Diagnosis and Evaluation of Disease Severity. ACTA ACUST UNITED AC 2013. [DOI: 10.5812/thrita.11795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lenglet A, Liabeuf S, Desjardins L, Neirynck N, Glorieux G, Lemke HD, Vanholder R, Brazier M, Choukroun G, Massy ZA. Prognostic Implications of Plasma Myoglobin Levels in Patients with Chronic Kidney Disease. Int J Artif Organs 2012. [DOI: 10.1177/039139881203501101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aurélie Lenglet
- French National Institute of Health and Medical Research (INSERM), ERI-12 (EA 4292), Amiens - France
- Clinical Research Center-Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardie, Amiens - France
| | - Sophie Liabeuf
- French National Institute of Health and Medical Research (INSERM), ERI-12 (EA 4292), Amiens - France
- Clinical Research Center-Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardie, Amiens - France
| | - Lucie Desjardins
- French National Institute of Health and Medical Research (INSERM), ERI-12 (EA 4292), Amiens - France
- Clinical Research Center-Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardie, Amiens - France
| | - Nathalie Neirynck
- Nephrology-Dialysis-Transplantation Department, Department of Internal Medicine, University Hospital, Gent - Belgium
| | - Griet Glorieux
- Nephrology-Dialysis-Transplantation Department, Department of Internal Medicine, University Hospital, Gent - Belgium
| | | | - Raymond Vanholder
- Nephrology-Dialysis-Transplantation Department, Department of Internal Medicine, University Hospital, Gent - Belgium
| | - Michel Brazier
- French National Institute of Health and Medical Research (INSERM), ERI-12 (EA 4292), Amiens - France
- Laboratory of Endocrine and Bone Biology, Amiens University Hospital, Amiens - France
| | - Gabriel Choukroun
- French National Institute of Health and Medical Research (INSERM), ERI-12 (EA 4292), Amiens - France
- Nephrology-Internal Medicine-Dialysis-Transplantation-Intensive Care Department, Amiens University Hospital, Amiens - France
| | - Ziad A. Massy
- French National Institute of Health and Medical Research (INSERM), ERI-12 (EA 4292), Amiens - France
- Clinical Research Center-Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardie, Amiens - France
- Nephrology-Internal Medicine-Dialysis-Transplantation-Intensive Care Department, Amiens University Hospital, Amiens - France
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Razavizade M, Jamali R, Arj A, Talari H. Serum parameters predict the severity of ultrasonographic findings in non-alcoholic fatty liver disease. Hepatobiliary Pancreat Dis Int 2012; 11:513-20. [PMID: 23060397 DOI: 10.1016/s1499-3872(12)60216-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Controversy exists about the correlation between liver ultrasonography and serum parameters for evaluating the severity of liver involvement in non-alcoholic fatty liver disease (NAFLD). This study was designed to determine the association between liver ultrasonography staging in NAFLD and serum parameters correlated with disease severity in previous studies; and set optimal cut-off points for those serum parameters correlated with NAFLD staging at ultrasonography, in order to differentiate ultrasonographic groups (USGs). METHODS This cross-sectional study evaluated outpatients with evidence of NAFLD in ultrasonography referred to a general hospital. Those with positive viral markers, abnormal serum ceruloplasmin or gamma-globulin concentrations were excluded. A radiologist performed the ultrasonography staging and stratified the patients into mild, moderate, and severe groups. Fasting serum alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase, triglyceride (TG), high and low density lipoprotein (HDL, LDL), and cholesterol were checked. RESULTS Two hundred and forty-five patients with a mean age (+/-standard deviation) of 41.63(+/-11.46) years were included. There were no significant differences when mean laboratory concentrations were compared between moderate and severe USGs. Therefore, these groups were combined to create revised USGs ("mild" versus "moderate or severe"). There were associations between the revised USGs, and ALT, TG, HDL levels, and diabetes mellitus [odds ratios=2.81 (95% confidence interval (CI): 1.37-5.76), 2.48 (95% CI: 1.29- 4.78), 0.36 (95% CI: 0.18-0.74), and 5.65 (95% CI: 2.86-11.16) respectively; all P values <0.01]. A cut-off value of 32.5 mg/dL for ALT gave a sensitivity of 70% and a specificity of 62%, for differentiating between the revised USGs. CONCLUSIONS Serum ALT, TG, and HDL concentrations seem to be associated with the staging by liver ultrasonography in NAFLD. They might be used to predict the staging of liver ultrasonography in these patients.
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Affiliation(s)
- Mohsen Razavizade
- Deparmtent of Gastroenterology, Kashan University of Medical Sciences, Kashan, Iran
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