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Bucci T, Pastori D, Pignatelli P, Ntaios G, Abdul-Rahim AH, Violi F, Lip GY. Albumin Levels and Risk of Early Cardiovascular Complications After Ischemic Stroke: A Propensity-Matched Analysis of a Global Federated Health Network. Stroke 2024; 55:604-612. [PMID: 38323429 PMCID: PMC10896196 DOI: 10.1161/strokeaha.123.044248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND No studies have investigated the association between albumin levels and the risk of early cardiovascular complications in patients with ischemic stroke. METHODS Retrospective analysis with a federated research network (TriNetX) based on electronic medical records (International Classification of Diseases-Tenth Revision-Clinical Modification and logical observation identifiers names and codes) mainly reported between 2000 and 2023, from 80 health care organizations in the United States. Based on albumin levels measured at admission to the hospital, patients with ischemic stroke were categorized into 2 groups: (1) reduced (≤3.4 g/dL) and (2) normal (≥3.5 g/dL) albumin levels. The primary outcome was a composite of all-cause death, heart failure, atrial fibrillation, ventricular arrhythmias, myocardial infarction, and Takotsubo cardiomyopathy 30 days from the stroke. Secondary outcomes were the risk for each component of the primary outcome. Cox regression analyses were used to calculate hazard ratios (HRs) and 95% CIs following propensity score matching. RESULTS Overall, 320 111 patients with stroke had normal albumin levels (70.9±14.7 years; 48.9% females) and 183 729 (57.4%) had reduced albumin levels (72.9±14.3 years; 50.3% females). After propensity score matching, the primary outcomes occurred in 36.0% of patients with reduced and 26.1% with normal albumin levels (HR, 1.48 [95% CI, 1.46-1.50]). The higher risk in patients with reduced albumin levels was consistent also for all-cause death (HR, 2.77 [95% CI, 2.70-2.84]), heart failure (HR, 1.31 [95% CI, 1.29-1.34]), atrial fibrillation (HR, 1.11 [95% CI, 1.09-1.13]), ventricular arrhythmias (HR, 1.38 [95% CI, 1.30-1.46]), myocardial infarction (HR, 1.60 [95% CI, 1.54-1.65]), and Takotsubo cardiomyopathy (HR, 1.51 [95% CI, 1.26-1.82]). The association between albumin levels and the risk of cardiovascular events was independent of advanced age, sex, multimorbidity, and other causes of hypoalbuminemia. A progressively increased risk of adverse events was found in patients with mild and severe reduced compared to normal albumin levels. CONCLUSIONS Albumin levels are associated with the risk of early cardiovascular events and death in patients with ischemic stroke. The potential pathophysiological or therapeutic roles of albumin in patients with stroke warrant further investigation.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Department of General and Specialized Surgery, Sapienza University of Rome, Italy (T.B.)
| | - Daniele Pastori
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Azmil H. Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Stroke Division, Department of Medicine for Older People, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom (A.H.A.-R.)
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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Li Y, Guan L, Ning C, Zhang P, Zhao Y, Liu Q, Ping P, Fu S. Machine learning-based models to predict one-year mortality among Chinese older patients with coronary artery disease combined with impaired glucose tolerance or diabetes mellitus. Cardiovasc Diabetol 2023; 22:139. [PMID: 37316853 DOI: 10.1186/s12933-023-01854-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE An accurate prediction of survival prognosis is beneficial to guide clinical decision-making. This prospective study aimed to develop a model to predict one-year mortality among older patients with coronary artery disease (CAD) combined with impaired glucose tolerance (IGT) or diabetes mellitus (DM) using machine learning techniques. METHODS A total of 451 patients with CAD combined with IGT and DM were finally enrolled, and those patients randomly split 70:30 into training cohort (n = 308) and validation cohort (n = 143). RESULTS The one-year mortality was 26.83%. The least absolute shrinkage and selection operator (LASSO) method and ten-fold cross-validation identified that seven characteristics were significantly associated with one-year mortality with creatine, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and chronic heart failure being risk factors and hemoglobin, high density lipoprotein cholesterol, albumin, and statins being protective factors. The gradient boosting machine model outperformed other models in terms of Brier score (0.114) and area under the curve (0.836). The gradient boosting machine model also showed favorable calibration and clinical usefulness based on calibration curve and clinical decision curve. The Shapley Additive exPlanations (SHAP) found that the top three features associated with one-year mortality were NT-proBNP, albumin, and statins. The web-based application could be available at https://starxueshu-online-application1-year-mortality-main-49cye8.streamlitapp.com/ . CONCLUSIONS This study proposes an accurate model to stratify patients with a high risk of one-year mortality. The gradient boosting machine model demonstrates promising prediction performance. Some interventions to affect NT-proBNP and albumin levels, and statins, are beneficial to improve survival outcome among patients with CAD combined with IGT or DM.
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Affiliation(s)
- Yan Li
- Department of Endocrinology, People's Hospital of Macheng City, Hubei, China
| | - Lixun Guan
- Hematology Department, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Chaoxue Ning
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Pei Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Qiong Liu
- Medical Care Center, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Ping Ping
- General Station for Drug and Instrument Supervision and Control, Joint Logistic Support Force of Chinese People's Liberation Army, Beijing, China.
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.
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3
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Zou YM, Zhou DM, Wu MN, Zhao XY. A nomogram diagnostic cardiovascular disease in patients with erythrodermic psoriasis in Chinese. Front Immunol 2023; 14:1159957. [PMID: 37334364 PMCID: PMC10272766 DOI: 10.3389/fimmu.2023.1159957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Objective Patients with erythrodermic psoriasis (EP) are associated with an increased risk of cardiovascular disease (CVD), because of the more severe inflammation in the skin areas. This study aimed to develop a diagnostic model for the risk of CVD in EP patients based on the available features and multidimensional clinical data. Methods A total of 298 EP patients from Beijing Hospital of Traditional Chinese Medicine were retrospectively included in this study from May 5th, 2008, to March 3rd, 2022. Of them, 213 patients were selected as the development set by random sampling, and clinical parameters were analyzed by univariate and backward stepwise regression. Whereas the remaining 85 patients were randomly selected as the validation set. The model performance was later assessed in terms of discrimination, calibration, and clinical usefulness. Results In the development set, the CVD rate was 9%, which was independently correlated with age, glycated albumin (GA>17%), smoking, albumin (ALB<40 g/L), and lipoprotein(a) (Lp(a)>300 mg/L). The area under the ROC curve (AUC) value was 0.83 (95% confidence interval CI, 0.73,0.93). For the validation set of EP patients, the AUC value was 0.85 (95%CI, 0.76,0.94). According to decision curve analysis, our model exhibited favorable clinical applicability. Conclusion EP patients with age, GA>17%, smoking, ALB<40 g/L, and Lp(a)>300 mg/L are associated with a higher risk of CVD. The nomogram model performs well in predicting the probability of CVD in EP patients, which may help improve perioperative strategies and good treatment outcomes.
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Affiliation(s)
- Yue-Min Zou
- Beijing University of Chinese Medicine, Beijing, China
| | - Dong-Mei Zhou
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Man-Ning Wu
- Beijing University of Chinese Medicine, Beijing, China
| | - Xin-Yuan Zhao
- Beijing University of Chinese Medicine, Beijing, China
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Low serum albumin is associated with mortality and arterial and venous ischemic events in acutely ill medical patients. Results of a retrospective observational study. Thromb Res 2023; 225:1-10. [PMID: 36898171 DOI: 10.1016/j.thromres.2023.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND In general population hypoalbuminemia is associated with poor survival. Aim of this study was to assess the impact of hypoalbuminemia on mortality and venous and arterial ischemic events in hospitalized acutely ill medical patients. PATIENTS AND METHODS Retrospective observational analysis from the "REgistro POliterapie SIMI" (REPOSI). Patients were followed up to 12 months. Serum albumin was obtained in each patient. Mortality and ischemic events were registered throughout the follow-up period. RESULTS In the entire population including 4152 patients, median levels of serum albumin were 3.4 g/dL and 2193 patients (52.8 %) had levels ≤3.4 g/dL. Cases with albumin ≤3.4 g/dL were older, frailer, had more comorbidities and were most frequently underweight than those with serum albumin >3.4 g/dL. During the 12-month follow-up, all-cause mortality was 14.8 % (613 patients), with a higher rate in cases with serum albumin ≤3.4 g/dL (459, 20.9 % vs 154, 7.9 % in those with serum albumin >3.4 g/dL; p < 0.0001). During follow-up 121 ischemic events (2.9 %) were registered, 86 (71.1) arterial and 35 (28.9 %) venous. Proportional hazard analysis showed that patients with albumin ≤3.4 g/dL had a higher chance of dying. Furthermore, patients with albumin ≤3.4 g/dL had a higher likelihood of experiencing ischemic events. CONCLUSIONS Acutely ill hospitalized medical patients with serum levels ≤3.4 g/dL are at higher risk of all-cause mortality and ischemic events, measurement of albumin may help to identify hospitalized patients with a poorer prognosis.
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Violi F, Pignatelli P, Castellani V, Carnevale R, Cammisotto V. Gut dysbiosis, endotoxemia and clotting activation: A dangerous trio for portal vein thrombosis in cirrhosis. Blood Rev 2023; 57:100998. [PMID: 35985881 DOI: 10.1016/j.blre.2022.100998] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 01/28/2023]
Abstract
Liver cirrhosis (LC) is associated with portal venous thrombosis (PVT) in roughly 20% of cirrhotic patients but the underlying mechanism is still unclear. Low-grade endotoxemia by lipopolysaccharides (LPS), a component of outer gut microbiota membrane, is detectable in the portal circulation of LC and could predispose to PVT. LPS may translocate into systemic circulation upon microbiota dysbiosis-induced gut barrier dysfunction, that is a prerequisite for enhanced gut permeability and ensuing endotoxemia. Experimental and clinical studies provided evidence that LPS behaves a pro-thrombotic molecule so promoting clotting and platelet activation. Experiments conducted in the portal circulation of cirrhotic patients showed the existence of LPS-related enhanced thrombin generation as well as endothelial dysfunction, venous stasis, and platelet activation. The review will analyze 1) the pro-thrombotic role of endotoxemia in the context of LC 2) the biological plausibility linking endotoxemia with PVT and 3) the potentially interventional tools to lower endotoxemia and eventually hypercoagulation.
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Affiliation(s)
- Francesco Violi
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy; Mediterranea Cardiocentro-Napoli, Via Orazio, 2, 80122, Naples, Italy.
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy; Mediterranea Cardiocentro-Napoli, Via Orazio, 2, 80122, Naples, Italy
| | - Valentina Castellani
- Department of General and Specialized Surgery "Paride Stefanini", Sapienza University of Rome, Italy
| | - Roberto Carnevale
- Mediterranea Cardiocentro-Napoli, Via Orazio, 2, 80122, Naples, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 40100, Latina, Italy
| | - Vittoria Cammisotto
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy
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Shishkova D, Lobov A, Zainullina B, Matveeva V, Markova V, Sinitskaya A, Velikanova E, Sinitsky M, Kanonykina A, Dyleva Y, Kutikhin A. Calciprotein Particles Cause Physiologically Significant Pro-Inflammatory Response in Endothelial Cells and Systemic Circulation. Int J Mol Sci 2022; 23:ijms232314941. [PMID: 36499266 PMCID: PMC9738209 DOI: 10.3390/ijms232314941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Calciprotein particles (CPPs) represent an inherent mineral buffering system responsible for the scavenging of excessive Ca2+ and PO43- ions in order to prevent extraskeletal calcification, although contributing to the development of endothelial dysfunction during the circulation in the bloodstream. Here, we performed label-free proteomic profiling to identify the functional consequences of CPP internalisation by endothelial cells (ECs) and found molecular signatures of significant disturbances in mitochondrial and lysosomal physiology, including oxidative stress, vacuolar acidification, accelerated proteolysis, Ca2+ cytosolic elevation, and mitochondrial outer membrane permeabilisation. Incubation of intact ECs with conditioned medium from CPP-treated ECs caused their pro-inflammatory activation manifested by vascular cell adhesion molecule 1 (VCAM1) and intercellular adhesion molecule 1 (ICAM1) upregulation and elevated release of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1/ C-C motif ligand 2 (MCP-1/CCL2). Among the blood cells, monocytes were exclusively responsible for CPP internalisation. As compared to the co-incubation of donor blood with CPPs in the flow culture system, intravenous administration of CPPs to Wistar rats caused a considerably higher production of chemokines, indicating the major role of monocytes in CPP-triggered inflammation. Upregulation of sICAM-1 and IL-8 also suggested a notable contribution of endothelial dysfunction to systemic inflammatory response after CPP injections. Collectively, our results demonstrate the pathophysiological significance of CPPs and highlight the need for the development of anti-CPP therapies.
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Affiliation(s)
- Daria Shishkova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Arseniy Lobov
- Laboratory of Regenerative Biomedicine, Institute of Cytology of the RAS, 4 Tikhoretskiy Prospekt, 194064 St. Petersburg, Russia
| | - Bozhana Zainullina
- Centre for Molecular and Cell Technologies, St. Petersburg State University, Universitetskaya Embankment, 7/9, 199034 St. Petersburg, Russia
| | - Vera Matveeva
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Victoria Markova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anna Sinitskaya
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Elena Velikanova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Maxim Sinitsky
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anastasia Kanonykina
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Yulia Dyleva
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anton Kutikhin
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
- Correspondence: ; Tel.: +7-960-907-7067
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Manolis AA, Manolis TA, Melita H, Mikhailidis DP, Manolis AS. Low serum albumin: A neglected predictor in patients with cardiovascular disease. Eur J Intern Med 2022; 102:24-39. [PMID: 35537999 DOI: 10.1016/j.ejim.2022.05.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 01/02/2023]
Abstract
Albumin, the most abundant circulating protein in blood, is an essential protein which binds and transports various drugs and substances, maintains the oncotic pressure of blood and influences the physiological function of the circulatory system. Albumin also has anti-inflammatory, antioxidant, and antithrombotic properties. Evidence supports albumin's role as a strong predictor of cardiovascular (CV) risk in several patient groups. Its protective role extends to those with coronary artery disease, heart failure, hypertension, atrial fibrillation, peripheral artery disease or ischemic stroke, as well as those undergoing revascularization procedures or with aortic stenosis undergoing transcatheter aortic valve replacement, and patients with congenital heart disease and/or endocarditis. Hypoalbuminemia is a strong prognosticator of increased all-cause and CV mortality according to several cohort studies and meta-analyses in hospitalized and non-hospitalized patients with or without comorbidities. Normalization of albumin levels before discharge lowers mortality risk, compared with hypoalbuminemia before discharge. Modified forms of albumin, such as ischemia modified albumin, also has prognostic value in patients with coronary or peripheral artery disease. When albumin is combined with other risk factors, such as uric acid or C-reactive protein, the prognostic value is enhanced. Although albumin supplementation may be a plausible approach, its efficacy has not been established and in patients with hypoalbuminemia, priority is focused on diagnosing and managing the underlying condition. The CV effects of hypoalbuminemia and relevant issues are considered in this review. Large cohort studies and meta-analyses are tabulated and the physiologic effects of albumin and the deleterious effects of low albumin are pictorially illustrated.
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Affiliation(s)
| | - Theodora A Manolis
- Aiginiteio University Hospital, Athens University School of Medicine, Athens, Greece
| | - Helen Melita
- Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Lee YT, Lin CS, Fang WH, Lee CC, Ho CL, Wang CH, Tsai DJ, Lin C. Artificial Intelligence-Enabled Electrocardiography Detects Hypoalbuminemia and Identifies the Mechanism of Hepatorenal and Cardiovascular Events. Front Cardiovasc Med 2022; 9:895201. [PMID: 35770216 PMCID: PMC9234125 DOI: 10.3389/fcvm.2022.895201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Albumin, an important component of fluid balance, is associated with kidney, liver, nutritional, and cardiovascular diseases (CVD) and is measured by blood tests. Since fluid balance is associated with electrocardiography (ECG) changes, we established a deep learning model (DLM) to estimate albumin via ECG. Objective This study aimed to develop a DLM to estimate albumin via ECG and explored its contribution to future complications. Materials and Methods A DLM was trained for estimating ECG-based albumin (ECG-Alb) using 155,078 ECGs corresponding to albumin from 79,111 patients, and another independent 13,335 patients from an academic medical center and 11,370 patients from a community hospital were used for internal and external validation. The primary analysis focused on distinguishing patients with mild to severe hypoalbuminemia, and the secondary analysis aimed to provide additional prognostic value from ECG-Alb for future complications, which included mortality, new-onset hypoalbuminemia, chronic kidney disease (CKD), new onset hepatitis, CVD mortality, new-onset acute myocardial infarction (AMI), new-onset stroke (STK), new-onset coronary artery disease (CAD), new-onset heart failure (HF), and new-onset atrial fibrillation (Afib). Results The AUC to identify hypoalbuminemia was 0.8771 with a sensitivity of 56.0% and a specificity of 90.7% in the internal validation set, and the Pearson correlation coefficient was 0.69 in the continuous analysis. The most important ECG features contributing to ECG-Alb were ordered in terms of heart rate, corrected QT interval, T wave axis, sinus rhythm, P wave axis, etc. The group with severely low ECG-Alb had a higher risk of all-cause mortality [hazard ratio (HR): 2.45, 95% CI: 1.81-3.33] and the other hepatorenal and cardiovascular events in the internal validation set. The external validation set yielded similar results. Conclusion Hypoalbuminemia and its complications can be predicted using ECG-Alb as a novel biomarker, which may be a non-invasive tool to warn asymptomatic patients.
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Affiliation(s)
- Yung-Tsai Lee
- Division of Cardiovascular Surgery, Cheng Hsin Rehabilitation and Medical Center, Taipei City, Taiwan
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan
| | - Dung-Jang Tsai
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Chin Lin
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei City, Taiwan
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9
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Violi F, Pignatelli P, Vestri A, Spagnoli A, Cipollone F, Ceccarelli G, Oliva A, amitrano M, Pirro M, Taliani G, Cangemi R, Lichtner M, Pugliese F, Falcone M, Venditti M, Mastroianni CM, Loffredo L. THE ADA (AGE-D-DIMER-ALBUMIN) SCORE TO PREDICT THROMBOSIS IN SARS-CoV-2. Thromb Haemost 2022; 122:1567-1572. [DOI: 10.1055/a-1788-7592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2)-related
pneumonia is associated with venous and arterial thrombosis . Aim of the study was to find-out a
new score for predicting thrombosis in patients with SARS-CoV-2.
Methods: We included a
cohort of 674 patients affected by SARS-CoV-2, not requiring intensive care units, and
followed-up during the hospitalization until discharge. Routinary analyses performed at
in-hospital admission included also serum albumin and D-dimer while arterial and venous
thromboses were the end-points of the study.
Results: During the follow-up thrombotic events
110 were registered; patients with thrombotic events were older and had lower albumin and higher
D-dimer, compared to thrombotic event-free ones. On multivariable logistic regression with step
by stepwise procedure age, serum albumin, D-dimer, were independently associated with thrombotic
events. The linear combination of age, D-dimer, albumin allowed to build-up the ADA score, whose
AUC was 0.752 (95% CI, 0.708-0.795). ADA score was internally validated by bootstrap sampling
procedure giving an AUC of 0.752 (95% CI: 0.708 - 0.794).
Conclusions: Combination of age,
D-dimer, albumin in the ADA score allows identifying SARS-CoV-2 patients at higher risk of
thrombotic events.
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Affiliation(s)
- Francesco Violi
- Policlinico Umberto I, I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Roma, Italy
| | | | - Annarita Vestri
- BioMedical Statistics and Clinical Epidemiology Centre, Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases., University of Rome La Sapienza, Rome, Italy
| | | | | | | | - maria amitrano
- Medicine, Azienda Ospedaliera S. G. Moscatti Hospital, avellino, Italy
| | | | | | | | | | | | | | | | | | - Lorenzo Loffredo
- Medicina Interna e Specialità Mediche, Università La Sapienza, Rome, Italy
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Ali MS, Al-Lohedan HA. Experimental and Computational Investigation on the Interaction of Anticancer Drug Gemcitabine with Human Plasma Protein: Effect of Copresence of Ibuprofen on the Binding. Molecules 2022; 27:1635. [PMID: 35268736 PMCID: PMC8912049 DOI: 10.3390/molecules27051635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/24/2022] Open
Abstract
The interaction of common anticancer drug gemcitabine with human serum albumin (HSA) has been studied in detail. The effect of an omnipresent nonsteroidal anti-inflammatory drug ibuprofen was also seen on the binding of HSA and gemcitabine. A slight hyperchromic shift in the difference UV-visible absorption spectra of HSA on the addition of gemcitabine gave a primary idea of the possible complex formation between them. The inner filter effect, which happens due to the significant absorbance of the ligand at the excitation and/or emission wavelengths, played an important role in the observed fluorescence quenching of HSA by gemcitabine that can be understood by comparing the observed and corrected fluorescence intensities obtained at λex = 280 nm and 295 nm. Gemcitabine showed weak interaction with HSA, which took place via a dynamic quenching mechanism with 1:1 cooperative binding between them. Secondary structural analysis, based on circular dichroism (CD) spectroscopy, showed that low concentrations of gemcitabine did not affect the native structure of protein; however, higher concentrations affected it slightly with partial unfolding. For understanding the binding site of gemcitabine within HSA, both experimental (using site markers, warfarin and ibuprofen) as well as computational methods were employed, which revealed that the gemcitabine binding site is located between the interface of subdomain IIA and IIB within the close proximity of the warfarin site (drug site 1). The effect of ibuprofen on the binding was further elaborated because of the possibility of its coexistence with gemcitabine in the prescription given to the cancer patients, and it was noticed that, ibuprofen, even present in high amounts, did not affect the binding efficacy of gemcitabine with HSA. DFT analyses of various conformers of gemcitabine obtained from its docking with various structures of HSA (free and bounded with site markers), show that the stability of the gemcitabine molecule increased slightly after binding with ibuprofen-complexed HSA. Both experimental as well as computational results were in good agreement with each other.
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Affiliation(s)
- Mohd Sajid Ali
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
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11
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Baratta F, Bartimoccia S, Carnevale R, Stefanini L, Angelico F, Del Ben M. Oxidative stress mediated platelet activation in patients with congenital analbuminemia: Effect of albumin infusion. J Thromb Haemost 2021; 19:3090-3094. [PMID: 34614277 PMCID: PMC9293470 DOI: 10.1111/jth.15545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Congenital analbuminemia is a rare autosomal recessive inherited disorder characterized by strongly decreased concentration, or complete absence, of serum albumin (SA). Several lines of evidence indicate that SA has anti-thrombotic effect. In vivo platelet function and the role of oxidative stress (OS) in platelet aggregation promotion have never been studied in analbuminaemic patients. PATIENTS AND METHODS We report two cases of congenital analbuminemia in a 38-year-old male and in a 67-year-old woman. We analyzed platelet activation (PA) and OS at baseline and 2 h after 40 g human albumin infusion. PA was evaluated as platelet aggregation, sCD40L and surface αIIbβ3 integrin and P-selectin expression. OS was evaluated measuring serum sNOX2dp, and 8-iso-PGF2α. FINDINGS Analbuminemic patients displayed higher platelet aggregation, markers of PA and of OS. Albumin infusion reduced platelet activation by reducing oxidative stress.
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Affiliation(s)
- Francesco Baratta
- Department of Clinical Internal, Anaesthesiological and Cardiovascular SciencesSapienza University of RomeRomeItaly
| | - Simona Bartimoccia
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Roberto Carnevale
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
- Mediterranea Cardiocentro‐NapoliNapoliItaly
| | - Lucia Stefanini
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Francesco Angelico
- Department of Public Health and Infectious DiseasesSapienza UniversityRomeItaly
| | - Maria Del Ben
- Department of Clinical Internal, Anaesthesiological and Cardiovascular SciencesSapienza University of RomeRomeItaly
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12
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Bicciré FG, Pastori D, Tanzilli A, Pignatelli P, Viceconte N, Barillà F, Versaci F, Gaudio C, Violi F, Tanzilli G. Low serum albumin levels and in-hospital outcomes in patients with ST segment elevation myocardial infarction. Nutr Metab Cardiovasc Dis 2021; 31:2904-2911. [PMID: 34344545 DOI: 10.1016/j.numecd.2021.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/22/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Low serum albumin (SA) is associated with an increased risk of long-term adverse events (AEs) among patients with chronic coronary syndromes. Its prognostic role in patients with ST-elevation myocardial infarction (STEMI) is less clear. To investigate the association between low SA and in-hospital AEs in STEMI patients. METHODS AND RESULTS Multicenter retrospective cohort study of 220 STEMI patients undergoing primary percutaneous coronary intervention within 12 h from the onset of symptoms. Hypoalbuminemia was defined by serum SA <35 g/L. SA. In-hospital AEs were defined as cardiogenic shock, resuscitated cardiac arrest and death. Median SA was 38 (IQR 35.4-41.0) g/L and 37 (16.8%) patients showed hypoalbuminemia (<35 g/L) on admission. Patients with hypoalbuminemia were older, more frequently women and diabetics, prior CAD and HF. Furthermore, they showed lower hemoglobin levels and impaired renal function. At multivariable logistic regression analysis, diabetes (odds ratio [OR]:4.59, 95% confidence interval [CI] 1.71-12.28, p = 0.002) and haemoglobin (OR:0.52, 95%CI 0.37-0.72, p < 0.001) were associated with low SA. In a subgroup of 132 patients, SA inversely correlated with D-Dimer (rS -0.308, p < 0.001). Globally, twenty-eight (14.6%) AEs were recorded. Hypoalbuminemia (OR:3.43, 95%CI 1.30-9.07, p = 0.013), high-sensitive (HS)-Troponin peak above median (OR:5.41, 95%CI 1.99-14.7, p = 0.001), C-reactive protein (CRP) peak above median (OR:6.03, 95%CI 2.02-18.00, p = 0.001), and in-hospital infection (OR:3.61, 95%CI 1.21-10.80, p = 0.022) were associated with AEs. CONCLUSION Low SA levels are associated with worse in-hospital AEs in STEMI patients, irrespective of HS-troponin and CRP plasma levels. Our findings suggest that low SA may contribute to the pro-thrombotic phenotype of these patients.
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Affiliation(s)
- Flavio Giuseppe Bicciré
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | | | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy; Clinica Mediterranea, Naples, Italy
| | - Nicola Viceconte
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesco Barillà
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | | | - Carlo Gaudio
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy; Clinica Mediterranea, Naples, Italy.
| | - Gaetano Tanzilli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
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13
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Violi F, Ceccarelli G, Cangemi R, Cipollone F, D'Ardes D, Oliva A, Pirro M, Rocco M, Alessandri F, D'Ettorre G, Lichtner M, Pignatelli P, Ferro D, Ruberto F, Lip GYH, Pugliese F, Mastroianni CM. Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19): relationship with mortality. Intern Emerg Med 2021; 16:1231-1237. [PMID: 34218413 PMCID: PMC8255055 DOI: 10.1007/s11739-020-02621-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. METHODS Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. RESULTS Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8-12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4-5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28-0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59-4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014-1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277-0.723; p = 0.001) predicted morality. CONCLUSIONS Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.
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Affiliation(s)
- Francesco Violi
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Roma, Italy.
- Mediterranea Cardiocentro, Naples, Italy.
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cipollone
- Clinica Medica, Department of Medicine and Aging, "G. D'Annunzio, University of Chieti-Pescara, Chieti, Italy
| | - Damiano D'Ardes
- Clinica Medica, Department of Medicine and Aging, "G. D'Annunzio, University of Chieti-Pescara, Chieti, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Monica Rocco
- Dipartimento Emergenza E Accettazione, Ospedale Universitario Sant'Andrea, Rome, Italy
| | - Francesco Alessandri
- Department of General Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Roma, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Domenico Ferro
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Roma, Italy
| | - Franco Ruberto
- Department of General Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Francesco Pugliese
- Department of General Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
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14
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Sciacqua A, Andreozzi F, Succurro E, Pastori D, Cammisotto V, Armentaro G, Mannino GC, Fiorentino TV, Pignatelli P, Angiolillo DJ, Sesti G, Violi F. Impaired Clinical Efficacy of Aspirin in Hypoalbuminemic Patients With Diabetes Mellitus. Front Pharmacol 2021; 12:695961. [PMID: 34239442 PMCID: PMC8258313 DOI: 10.3389/fphar.2021.695961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: To investigate the impact of albumin levels on the aspirin efficacy, since aspirin inhibits platelet aggregation (PA) by cyclooxygenase one irreversible acetylation that is less effective in patients with type 2 diabetes mellitus (T2DM). Patients and Methods: A total of 612 aspirin (100 mg/day)-treated T2DM patients were followed-up for 54.4 ± 7.3 months. The primary endpoint, a composite of cardiovascular events (CVEs) including CV death, myocardial infarction, ischemic stroke and coronary revascularization, was analysed according to baseline values of serum albumin (≥ or < 3.5 g/dL). Serum thromboxane (Tx)B2 was also measured. Results: 250 (40.8%) patients had serum albumin < 3.5 g/dL; these patients were overweight and had higher values of fibrinogen (p = 0.009), high sensitivity C-reactive protein (p = 0.001) and fasting plasma glucose (p < 0.0001) compared to those with albumin ≥ 3.5 g/dL. During follow-up, 86 CVEs were recorded, 49 and 37 in patients with serum albumin < or ≥3.5 g/dL, respectively (p = 0.001). At multivariable Cox regression analysis, serum albumin < 3.5 g/dL (hazard ratio [HR] 1.887, 95% confidence interval [CI] 1.136–3.135, p = 0.014), age (HR 1.552 for every 10 years, 95%CI 1.157–2.081, p = 0.003), fasting plasma glucose (HR 1.063, 95%CI 1.022–1.105, p = 0.002) and beta-blocker use (HR 0.440, 95%CI 0.270–0.717, p = 0.001) were associated to CVEs. Serum TxB2 levels (n = 377) were 0.32 ± 0.12 and 0.24 ± 0.12 ng/ml in patients with albumin < or ≥ 3.5 g/dL, respectively (p < 0.001). Conclusion: In T2DM patients, the efficacy of aspirin varies according to albumin levels. Hypoalbuminemia associated with impaired TxB2 inhibition and an increased risk of long-term CVEs.
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Affiliation(s)
- Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anaesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittoria Cammisotto
- Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Gaia C Mannino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale Pignatelli
- Department of Clinical, Internal, Anaesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza, University of Rome, Rome, Italy
| | - Francesco Violi
- Department of Clinical, Internal, Anaesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.,Mediterranea Cardiocentro, Napoli, Italy
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15
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Arques S. Serum albumin and cardiovascular disease: State-of-the-art review. Ann Cardiol Angeiol (Paris) 2020; 69:192-200. [PMID: 32797938 DOI: 10.1016/j.ancard.2020.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Cardiovascular disease is the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory conditions and oxidative stress are at the forefront of the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin has many physiological properties, including in particular antioxidant, anti-inflammatory, anticoagulant and anti-platelet aggregation activity. It also plays an essential role in the exchange of fluids across the capillary membrane. Hypoalbuminemia is a powerful prognostic marker in the general population as well as in many disease states. In the more specific context of cardiovascular disease, low serum albumin is independently associated with the development of various deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation, stroke and venous thromboembolism. Low serum albumin has also emerged as a potent prognostic parameter in patients with cardiovascular disease regardless of usual prognostic markers. Remarkably, its potent prognostic value persists after adjusting for causative confounders such as malnutrition and inflammation. This prognostic value probably refers primarily to the syndrome of malnutrition-inflammation and the severity of comorbidities. Nevertheless, several recent meta-analyses strongly support the hypothesis that hypoalbuminemia may act as an unrecognized, potentially modifiable risk factor contributing to the emergence and progression of cardiovascular disease, primarily by exacerbating oxidative stress, inflammation and platelet aggregation, and by favouring peripheral congestion and pulmonary edema. Currently, it is unknown whether prevention and correction of low serum albumin offers a benefit to patients with or at risk for cardiovascular disease, and further studies are critically needed in this setting.
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Affiliation(s)
- S Arques
- Service de Cardiologie, Centre hospitalier Edmond Garcin, Avenue des Soeurs Gastine, 13400 Aubagne, France.
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16
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Liu H, Zhang J, Yu J, Li D, Jia Y, Cheng Y, Zhang Q, Liao X, Liu Y, Wu J, Zeng Z, Cao Y, Zeng R, Wan Z, Gao Y. Prognostic value of serum albumin-to-creatinine ratio in patients with acute myocardial infarction: Results from the retrospective evaluation of acute chest pain study. Medicine (Baltimore) 2020; 99:e22049. [PMID: 32871964 PMCID: PMC7458165 DOI: 10.1097/md.0000000000022049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The long-term association between serum albumin-to-creatinine ratio (sACR) and poor patient outcomes in acute myocardial infarction (AMI) remains unclear. This study aimed to determine whether sACR was a predictor of poor long-term survival in patients with AMI.This was a study of patients with AMI in the emergency department (ED) from the retrospective multicenter study for early evaluation of acute chest pain (REACP) study. The patients were categorized into tertiles (T1, T2, and T3) based on the admission sACR (0.445 and 0.584 g/μmol). Baseline sACR at admission to the ED was predictive of adverse outcomes. The primary outcome was all-cause mortality within the follow-up period. Cox proportional hazards models were performed to investigate the association between sACR and all-cause mortality in patients with AMI.A total of 2250 patients with AMI were enrolled, of whom 229 (10.2%) died within the median follow-up period of 10.7 (7.2-14.6) months. Patients with a lower sACR had higher all-cause mortality and adverse outcomes rates than patients with a higher sACR. Kaplan-Meier survival analysis showed that patients with a higher sACR had a higher cumulative survival rate (P < .001). Cox regression analysis showed that a decreased sACR was an independent predictor of all-cause mortality [T2 vs T1: hazard ratio (HR); 0.550, 95% confidence interval (95% CI), 0.348-0.867; P = .010 and T3 vs T1: HR, 0.305; 95% CI, 0.165-0.561; P < .001] and cardiac mortality (T2 vs T1: HR, 0.536; 95% CI, 0.332-0.866; P = .011 and T3 vs T1: HR, 0.309; 95% CI, 0.164-0.582, P < .001).The sACR at admission to ED was independently associated with adverse outcomes, indicating that baseline sACR was a useful biomarker to identify high-risk patients with AMI at an early phase in ED.
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Affiliation(s)
- Hong Liu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Jianna Zhang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Jing Yu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Jia
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yisong Cheng
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Qin Zhang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- Department of General Practice, International Hospital of Sichuan Province, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanmei Liu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Wu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Cao
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
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Oxidative Modifications in Advanced Atherosclerotic Plaques: A Focus on In Situ Protein Sulfhydryl Group Oxidation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:6169825. [PMID: 31998439 PMCID: PMC6973184 DOI: 10.1155/2020/6169825] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 12/21/2022]
Abstract
Although oxidative stress has been long associated with the genesis and progression of the atherosclerotic plaque, scanty data on its in situ effects on protein sulfhydryl group modifications are available. Within the arterial wall, protein sulfhydryls and low-molecular-weight (LMW) thiols are involved in the cell regulation of both Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) levels and are a target for several posttranslational oxidative modifications that take place inside the atherosclerotic plaque, probably contributing to both atherogenesis and atherosclerotic plaque progression towards complicated lesions. Advanced carotid plaques are characterized by very high intraplaque GSH levels, due to cell lysis during apoptotic and/or necrotic events, probably responsible for the altered equilibrium among protein sulfhydryls and LMW thiols. Some lines of evidence show that the prooxidant environment present in atherosclerotic tissue could modify filtered proteins also by protein-SH group oxidation, and demonstrate that particularly albumin, once filtered, represents a harmful source of homocysteine and cysteinylglycine inside the plaque. The oxidative modification of protein sulfhydryls, with particular emphasis to protein thiolation by LMW thiols and its association with atherosclerosis, is the main topic of this review.
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