1
|
Karaduman A, Balaban İ, Biyiklı K, Keten MF, Kalkan S, Kahyaoglu M, Celik M, Gecmen Ç. Relationship of the modified Glasgow Prognostic Score with peripheral artery disease severity and procedure success in patients who had undergone endovascular treatment. Vascular 2024:17085381241273281. [PMID: 39137919 DOI: 10.1177/17085381241273281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES The modified Glasgow Prognostic Score (mGPS) is one type of inflammation-based index; it includes data on elevated C-reactive protein and reduced albumin content. The predictive value of mGPS for outcomes is investigated in various diseases such as cancer, heart failure, myocardial infarction, acute pulmonary embolism, and inflammatory bowel diseases. This study aimed to evaluate the link between mGPS and the severity and complexity of peripheral arterial disease (PAD) as determined by the Transatlantic Intercommunal Consensus Document (TASC-II) classification and the prediction value of mGPS for procedural success in patients undergoing endovascular treatment (EVT). METHODS Our study included 203 consecutive patients receiving EVT for atherosclerotic obstruction of aortoiliac, femoro-popliteal, and below-knee arteries between January 2019 and February 2020. The lesion characteristics were determined according to categories in the TASC-II. Operational failure is the inability to position the guidewire through the occluded lesion following percutaneous intervention or achieve distal perfusion following EVT. RESULTS In our study, we observed 136 patients (%6) with TASC A-B lesions and 67 patients (%33) with TASC C-D lesions. EVT was performed on the femoro-popliteal artery in 59.4% of the patients, on the aortoiliac artery in 30.7%, and on the below-the-knee artery in 9.9%. mGPS was an independent predictor of severe PAD (OR: 17.943, 95% CI: 5.120-62.882; p < .001) and procedural success (odds ratio: 0.004; 95% CI: 0.001-0.099; p < .001). Additionally, we identified age and the presence of a TASC D lesion as independent predictors of interventional success (OR: 0.938, 95% CI: 0.819-0.979; p: .034; OR: 0.104, 95% CI: 0.107-0.643; p: .015, respectively). CONCLUSION We determined that mGPS independently predicts PAD complexity and severity based on TASC-II classification; the EVT success rate is lower in patients with high mGPS.
Collapse
Affiliation(s)
- Ahmet Karaduman
- Department of Cardiology, Bitlis State Hospital, Bitlis, Turkey
| | - İsmail Balaban
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | - Kadir Biyiklı
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | | | - Semih Kalkan
- Department of Cardiology, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Kahyaoglu
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Celik
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| | - Çetin Gecmen
- Hamidiye School of Medicine, Kosuyolu Heart, Education and Research Institute, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
2
|
Luo G, Feng F, Xu H, Li Y, Zou W. Prognostic significance of the hs-CRP/Alb ratio for cardiovascular events in patients with end-stage renal disease undergoing maintenance hemodialysis. Am J Transl Res 2024; 16:3108-3116. [PMID: 39114698 PMCID: PMC11301510 DOI: 10.62347/cvqk8523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/04/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To evaluate the predictive power of the high-sensitivity C-reactive protein (hs-CRP) to albumin (Alb) ratio for cardiovascular events in patients receiving maintenance hemodialysis (MHD) for end-stage renal disease (ESRD). METHODS This retrospective study enrolled 202 ESRD patients undergoing MHD at Bobai County People's Hospital from November 2020 to November 2022, with follow-up extending to November 2023. Patients were divided into two groups based on the occurrence of cardiovascular events during follow-up: the occurrence group (n = 92) and the non-occurrence group (n = 110). Clinical data were compared between these groups. Independent risk factors for cardiovascular events post-MHD were identified using a multivariate logistic regression model. The hs-CRP/Alb ratio's predictive utility was assessed through receiver operating characteristic (ROC) curve analysis, establishing an optimal cutoff value. A decision tree prediction model was developed to further delineate the probability of cardiovascular events. RESULTS The occurrence group was older and had a longer duration of dialysis compared to the non-occurrence group (P < 0.05). They also showed a higher prevalence of diabetic and hypertensive nephropathy and a higher proportion of smokers (all P < 0.05). Notably lower levels of hemoglobin (HGB), triglycerides, total cholesterol, low-density lipoprotein, albumin (Alb), and calcium were detected (all P < 0.05), whereas β2-microglobulin (β2-mg), hs-CRP, phosphorus, and the hs-CRP/Alb ratio were markedly increased (all P < 0.05). Multivariate analysis revealed diabetic nephropathy or hypertensive nephropathy, a high hs-CRP/Alb ratio, and elevated phosphorus levels as risk factors for cardiovascular events, while high hemoglobin levels were protective (P < 0.05). The ROC analysis indicated the hs-CRP/Alb ratio (AUC = 0.884) outperformed other predictors with an optimal cutoff at 0.111. Patients with a hs-CRP/Alb ratio ≥ 0.111 were found to have a 29-fold increased risk of cardiovascular events (95% CI: 11.304-74.842). CONCLUSION The hs-CRP/Alb ratio is a significant predictive biomarker for cardiovascular events in ESRD patients undergoing MHD. An elevated hs-CRP/Alb ratio is associated with an increased risk of cardiovascular events, underscoring its utility in this patient population.
Collapse
Affiliation(s)
- Guangbin Luo
- Department of Nephrology, Bobai County People’s HospitalYulin 537600, Guangxi, China
| | - Fuqiang Feng
- Department of Internal Medicine, Bobai County People’s HospitalYulin 537600, Guangxi, China
| | - Hongyue Xu
- Department of Cardiovascular, Bobai County People’s HospitalYulin 537600, Guangxi, China
| | - Yilong Li
- Department of Nephrology, Bobai County People’s HospitalYulin 537600, Guangxi, China
| | - Weiyi Zou
- Department of Nephrology, Bobai County People’s HospitalYulin 537600, Guangxi, China
| |
Collapse
|
3
|
Özsin KK, Engin M, Sanrı US, Toktaş F, Kahraman N, Huysal K, Üstündağ Y, Yavuz Ş. Evaluation of the relationship between adjusted ischemia-modified albumin and the presence and severity of peripheral artery disease. Vascular 2024; 32:603-611. [PMID: 36437682 DOI: 10.1177/17085381221141473] [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] [Indexed: 02/17/2024]
Abstract
OBJECTIVES Albumin undergoes structural changes under ischemia and oxidative stress, turning into ischemia-modified albumin (IMA). It has been proposed as an early biomarker for various diseases associated with ischemia. We aimed to investigate the relationship between serum IMA and peripheral artery disease (PAD) and whether it is a risk marker for the severity of PAD. METHODS This prospective case-control study included 100 patients with lower extremity PAD and 50 volunteers without. Patients with resting pain, ulcer, and gangrene were excluded from the study. Patients with PAD included in the study were divided into two groups as mild claudication and moderate-severe claudication. Adjusted-IMA levels were calculated according to the median albumin values of the groups. The basic clinical features and laboratory findings of the participants were recorded and compared. Possible risk factors for presence and severity of PAD and IMA levels were examined by logistic regression and receiver-operating characteristic (ROC) curve analyses. RESULTS IMA and adjusted-IMA levels were significantly higher in the PAD group (p < 0.001, p < 0.001, respectively). IMA and adjusted-IMA levels were significantly higher in PAD group 2, which had moderate-to-severe claudication and more pronounced ischemic symptoms (p < 0.001, p < 0.001, respectively). Advanced age, presence of hypertension, smoking, low albumin levels, and high adjusted-IMA levels were independent predictors of PAD. There was a negative high correlation between adjusted-IMA levels and ABI (r: -0.666, p < 0.001, Spearman's correlation). ROC curve analysis demonstrated that adjusted-IMA cut-off values of 0.802 or above could predict presence and severity of peripheral artery disease with 70% sensitivity and 78% specificity (AUC: 0.825, 95% CI: 0.758-0.893, log rank p: 0.000). CONCLUSION We determinated that increased adjusted-IMA levels were a predictors of the presence and severity of PAD. In addition, adjusted-IMA values can be a valuable marker in the follow-up of clinical severity of PAD.
Collapse
Affiliation(s)
- Kadir K Özsin
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Mesut Engin
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Umut S Sanrı
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Faruk Toktaş
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Nail Kahraman
- Department of Cardiovascular Surgery, Bursa City Hospital, Bursa, Turkey
| | - Kağan Huysal
- Department of Clinical Biochemistry, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Yasemin Üstündağ
- Department of Clinical Biochemistry, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Şenol Yavuz
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| |
Collapse
|
4
|
Wu D, Nie J, Lin H, Zhang D, Ye Z, Zhang W, Xiao J. Characteristics and predictors of low-grade renal artery stenosis in female patients with CKD. Clin Exp Hypertens 2023; 45:2175849. [PMID: 36823499 DOI: 10.1080/10641963.2023.2175849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AIM Renal artery stenosis (RAS) is an important cause of chronic kidney disease (CKD). The main purpose of this study was to explore the clinical characteristics and predictors of low-grade RAS in female patients with CKD. METHODS One hundred and five female CKD patients from Huadong Hospital affiliated with Fudan University who underwent 3 T non-contrast renal artery magnetic resonance angiography (MRA) were analyzed. Basic statistics methods were used in the study, such as independent-sample t test,non-parametric test, binary logistic regression analysis and ROC analysis. RESULTS In this cross-sectional study, there were 50 patients with RAS and 55 without RAS (47.6% versus 52.4%). Binary logistic regression analysis demonstrated that low-level ALB and lymphocyte count, high-level SP, BUN and NLR were independent risk factors for low-grade RAS in female patients with CKD. ROC analysis indicated that eGFR, FeNa and UBCR, ALB, lymphocyte count and NLR had the best predictive value for low-grade RAS, especially eGFR with a sensitivity of 65.50% and specificity of 72.00% and FeNa with a sensitivity of 71.10% and specificity of 72.20% and BUCR with a sensitivity of 71.10% and specificity of 68.10%. CONCLUSION In female patients with CKD, FeNa, eGFR, ALB, UBCR, lymphocyte count and NLR may be good predictors of low-grade RAS, especially eGFR, FeNa and BUCR.
Collapse
Affiliation(s)
- Deping Wu
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China
| | - Jinli Nie
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China
| | - Huagang Lin
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China
| | - Dexian Zhang
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China
| | - Zhibin Ye
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China
| | - Wan Zhang
- Department of Vascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China
| | - Jing Xiao
- Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, P.R. China
| |
Collapse
|
5
|
Li B, Djahanpour N, Zamzam A, Syed MH, Jain S, Abdin R, Qadura M. Angiogenesis-related proteins as biomarkers for peripheral artery disease. Heliyon 2023; 9:e20166. [PMID: 37809892 PMCID: PMC10559913 DOI: 10.1016/j.heliyon.2023.e20166] [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: 02/19/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background Angiogenesis plays an important role in peripheral artery disease (PAD) and angiogenesis-related proteins may act as prognostic biomarkers. This study assesses the potential for angiogenesis-related proteins to predict adverse events associated with PAD. Methods This was a case-control study. Patients with PAD (n = 250) and without PAD (n = 125) provided blood samples and were followed prospectively for three years. Concentrations of 17 angiogenesis-related proteins were measured in plasma. The incidence of major adverse limb event (MALE), defined as a composite of major amputation or vascular intervention, was the primary outcome. Worsening PAD status, defined as a drop in ankle brachial index ≥ 0.15, was the secondary outcome. Multivariable regression adjusted for baseline characteristics was conducted to determine the prognostication value of angiogenesis-related proteins in predicting MALE. Findings Relative to patients without PAD, 8 proteins related to angiogenesis were expressed differentially in PAD patients. Worsening PAD status and MALE were observed in 52 (14%) and 83 (22%) patients, respectively. Hepatocyte growth factor (HGF) was the most reliable predictor of MALE (adjusted HR 0.79, 95% CI 0.15-0.86). Compared to individuals with high HGF, patients with low HGF had a decreased three-year freedom from MALE [66% vs 88%, p = 0.001], major amputation [93% vs 98%, p = 0.023], vascular intervention [68% vs 88%, p = 0.001], and worsening PAD status [81% vs 91%, p = 0.006]. Interpretation Measuring plasma levels of HGF in individuals with PAD can assist in identifying patients at elevated risk of adverse events related to PAD who may benefit from additional evaluation or treatment.
Collapse
Affiliation(s)
- Ben Li
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Canada
| | - Niousha Djahanpour
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Canada
| | - Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Canada
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Canada
| | - Shubha Jain
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Canada
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Canada
| |
Collapse
|
6
|
Hu S, Wang R, Ma T, Lei Q, Yuan F, Zhang Y, Wang D, Cheng J. Association between preoperative C-reactive protein to albumin ratio and late arteriovenous fistula dysfunction in hemodialysis patients: a cohort study. Sci Rep 2023; 13:11184. [PMID: 37433824 DOI: 10.1038/s41598-023-38202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
Abstract
Arteriovenous fistula (AVF) dysfunction is a critical complication in hemodialysis (HD) patients, with inflammation potentially contributing to its development. This retrospective cohort study aimed to investigate the association between preoperative C-reactive protein to albumin ratio (CAR) and AVF dysfunction in Chinese HD patients. A total of 726 adults with end-stage renal disease who underwent new AVF placement between 2011 and 2019 were included. Multivariable Cox regression and Fine and Gray competing risk models were employed to assess the relationship between CAR and AVF dysfunction, considering death and renal transplantation as competing risks. Among 726 HD patients, 29.2% experienced AVF dysfunction during a median follow-up of 36 months. Adjusted analyses revealed that higher CAR levels were associated with an increased risk of AVF dysfunction, with a 27% higher risk per one-unit increase in CAR. Furthermore, patients with CAR values ≥ 0.153 exhibited a 75% elevated risk compared to those with CAR values < 0.035 (P = 0.004). The relationship between CAR and AVF dysfunction varied by the site of internal jugular vein catheter placement (P for trend = 0.011). Notably, the Fine and Gray analysis confirmed the association between CAR and AVF dysfunction, with a 31% increased risk per one-unit increase in CAR. The highest CAR tertile remained an independent predictor of AVF dysfunction (HR = 1.77, 95% CI 1.21-2.58, P = 0.003). These findings highlight the potential of CAR as a prognostic marker for AVF dysfunction in Chinese HD patients. Clinicians should consider CAR levels and catheter placement site when assessing the risk of AVF dysfunction in this population.
Collapse
Affiliation(s)
- Shouliang Hu
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Runjing Wang
- Department of Basic Medicine, Xiamen Medical College, Xiamen, China
| | - Tean Ma
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Qingfeng Lei
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Fanli Yuan
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China
| | - Yong Zhang
- Division of Nephrology, Jianli County People's Hospital, Jingzhou, Hubei, China
| | - Dan Wang
- Central Laboratory, The First Hospital of Yangtze University, Jingzhou, Hubei, China.
| | - Junzhang Cheng
- Division of Nephrology, The First Hospital of Yangtze University, No.8, Aviation Road, Shashi District, Jingzhou, Hubei, China.
| |
Collapse
|
7
|
Li X, Qureshi AR, Suliman ME, Heimburger O, Barany P, Stenvinkel P, Lindholm B. Interleukin-6-to-Albumin Ratio as a Superior Predictor of Mortality in End-Stage Kidney Disease Patients. Am J Nephrol 2023; 54:268-274. [PMID: 37231796 PMCID: PMC10623391 DOI: 10.1159/000531191] [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: 03/28/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION In patients with chronic kidney disease (CKD), high interleukin-6 (IL-6) and low albumin circulating concentrations are associated with worse outcomes. We examined the IL-6-to-albumin ratio (IAR) as a predictor of risk of death in incident dialysis patients. METHODS In 428 incident dialysis patients (median age 56 years, 62% men, 31% diabetes mellitus, 38% cardiovascular disease [CVD]), plasma IL-6 and albumin were measured at baseline to calculate IAR. We compared the discrimination of IAR with other risk factors for predicting 60-month mortality using receiver operating characteristic curve (ROC) and analyzed the association of IAR with mortality using Cox regression analysis. We divided patients into IAR tertiles and analyzed: (1) cumulative incidence of mortality and the association of IAR with mortality risk in Fine-Gray analysis, taking kidney transplantation as competing risk and (2) the restricted mean survival time (RMST) to 60-month mortality and differences of RMST (∆RMST) between IAR tertiles to describe quantitative differences of survival time. RESULTS For all-cause mortality, the area under the ROC curve (AUC) for IAR was 0.700, which was greater than for IL-6 and albumin separately, while for CV mortality, the AUC for IAR (0.658) showed negligible improvement over IL-6 and albumin separately. In Cox regression analysis, IAR was significantly associated with all-cause mortality but not with CV mortality. Both high versus low and middle versus low tertiles of IAR associated with higher risk of all-cause mortality, subdistribution hazard ratio of 2.22 (95% CI 1.40-3.52) and 1.85 (95% CI 1.16-2.95), respectively, after adjusting for age, sex, diabetes mellitus, CVD, smoking, and estimated glomerular filtration rate. ∆RMST at 60 months showed significantly shorter survival time in middle and high IAR tertiles compared with low IAR tertile for all-cause mortality. CONCLUSIONS Higher IAR was independently associated with significantly higher all-cause mortality risk in incident dialysis patients. These results suggest that IAR may provide useful prognostic information in patients with CKD.
Collapse
Affiliation(s)
- Xiejia Li
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden,
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, China,
| | - Abdul Rashid Qureshi
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mohamed E Suliman
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimburger
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Shen X, Zhang X, Liu M, Dong N, Liao J, Zhou G, Cao Z, Yu L, Xu Y, Jiang Y, Wan Y, Fang Q. NT-proBNP Levels and Collateral Circulation Status in Patients with Acute Ischemic Stroke. DISEASE MARKERS 2023; 2023:5318012. [PMID: 37091896 PMCID: PMC10121344 DOI: 10.1155/2023/5318012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 04/25/2023]
Abstract
Methods In this study, 326 hospitalized patients with acute anterior circulation ischemic stroke (AACIS) were included. A comparison of the clinical characteristics of those with and without AF was conducted. The Spearman rank correlation was used for the correlation analysis of plasma NT-proBNP level, regional leptomeningeal collateral (rLMC) score, and computed tomography perfusion (CTP) status in the AF and non-AF groups. An analysis of multivariate linear regression was used to determine how plasma NT-proBNP level, rLMC score, and CTP status influenced the score on the NIHSS. Results There was a greater plasma NT-proBNP level in the AF group compared with the non-AF group, an increased CTP volume (including CTP ischemic volume, CTP infarct core volume, and CTP ischemic penumbra volume (P = 0.002)), higher NIHSS score on admission, and lower rLMC score (P < 0.001 for the remaining parameters). A negative correlation exists between plasma NT-proBNP level and rLMC score (r = -0.156, P = 0.022), but a positive correlation exists between plasma NT-proBNP level and both CTP ischemic volume and CTP infarct core volume (r = 0.148, P = 0.003) in the AF group, but not in the non-AF group. Multivariate linear regression analysis demonstrated that NT-proBNP, CTP ischemic penumbra volume, and rLMC score were associated with NIHSS score, and NT-proBNP was positively associated with NIHSS scores (95% confidence interval (CI), 0.000-0.002; P = 0.004) in the AF group, whatever in the unadjusted model or adjusted models, but not in the nonlarge artery atherosclerosis (LAA) group. Conclusion In AACIS patients with AF, NT-proBNP level negatively correlated with collateral status, positively with CTP ischemic volume, and positively with NIHSS score.
Collapse
Affiliation(s)
- Xiaozhu Shen
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Xianxian Zhang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Yancheng Third People's Hospital, Yancheng, China
| | - Mengqian Liu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Nan Dong
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China
| | - Juan Liao
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoqing Zhou
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiyong Cao
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liqiang Yu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiwen Xu
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Yi Jiang
- Department of Geriatrics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Yue Wan
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
9
|
Zavalaga-Zegarra HJ, Palomino-Gutierrez JJ, Ulloque-Badaracco JR, Mosquera-Rojas MD, Hernandez-Bustamante EA, Alarcon-Braga EA, Benites-Zapata VA, Herrera-Añazco P, Hernandez AV. C-Reactive Protein-to-Albumin Ratio and Clinical Outcomes in COVID-19 Patients: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:186. [PMID: 36006278 PMCID: PMC9414550 DOI: 10.3390/tropicalmed7080186] [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: 07/08/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
C-reactive protein-to-albumin ratio (CAR) is an independent risk factor in cardiovascular, cerebrovascular, and infectious diseases. Through this study, we investigated the CAR values with respect to the severity and mortality of COVID-19 patients. We performed a systematic review and meta-analysis to retrieve studies that evaluated CAR values upon hospital admission in relation to the severity or mortality of COVID-19 patients. We adopted a random-effect model to calculate the pooled mean difference (MD) and their 95% confidence intervals (CI). Quality assessment was appraised using a Newcastle−Ottawa scale and publication bias was assessed using the Begg-test and funnel plot. We equally performed a subgroup analysis using study location and a sensitivity analysis only with studies with low risk of bias. We analyzed 32 studies (n = 12445). Severe COVID-19 patients had higher on-admission CAR values than non-severe COVID-19 patients (MD: 1.69; 95% CI: 1.35−2.03; p < 0.001; I2 = 89%). Non-survivor patients with COVID-19 had higher CAR values than survivor patients (MD: 2.59; 95% CI: 1.95−3.23; p < 0.001; I2 = 92%). In sensitivity analysis, the relationship remained with a decreasing of heterogeneity for severity (MD: 1.22; 95% CI: 1.03−1.40; p < 0.001; I2 = 13%) and for mortality (MD: 2.99; 95% CI: 2.47−3.51; p < 0.001; I2 = 0%). High CAR values were found in COVID-19 patients who developed severe disease or died.
Collapse
Affiliation(s)
| | | | - Juan R. Ulloque-Badaracco
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Melany D. Mosquera-Rojas
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Enrique A. Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo 13011, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15012, Peru
| | - Esteban A. Alarcon-Braga
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15012, Peru
| | - Percy Herrera-Añazco
- Escuela de Enfermería, Universidad Privada San Juan Bautista, Lima 15067, Peru
- Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima 14072, Peru
| | - Adrian V. Hernandez
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Guías de Práctica Clínica y Evaluaciones de Tecnología Sanitaria, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15012, Peru
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, School of Pharmacy, University of Connecticut, Storrs, CT 06269, USA
| |
Collapse
|
10
|
A Novel Marker Indicating Restenosis in Superficial Femoral Artery: C Reactive Protein to Albumin Ratio. Ann Vasc Surg 2022; 86:158-167. [PMID: 35568327 DOI: 10.1016/j.avsg.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022]
Abstract
AIM In this study, we aimed to investigate the prognostic value of CAR for predicting restenosis in SFA lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention. METHODS The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. RESULTS According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs 10.3%, p<0.05) and mortality (31.3% vs 12.9%, p<0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs 3%, p<0.05). With respect to ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% CI: 0.611-0.706; p<0.01). CONCLUSION Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.
Collapse
|
11
|
Panç C, Güler A, Gürbak İ, Taşbulak Ö, Güner A, Kalkan AK, Yalçın AA, Ertürk M. Association between CRP/Albumin ratio and long-term mortality in patients with cHronIc Limb-threatening ischemia undergoing EndovaScular therapy Below The Knee: The ACHILES-BTK Registry. Ann Vasc Surg 2021; 82:172-180. [PMID: 34896550 DOI: 10.1016/j.avsg.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI), which presents with ischemic rest pain, ulceration, or gangrene, is a complex form of peripheral artery disease that can cause mortality and amputation. C-reactive protein (CRP), an inflammatory marker, indicates vascular inflammation resulting from the cytokine-dependent inflammatory process in the arterial wall and arterial atherosclerosis resulting from the inflammation. Lower albumin levels are also associated with peripheral artery disease. We investigated the association between CRP/Albumin ratio (CAR) and long-term mortality in patients with CLTI. METHODS A total of 172 patients who underwent endovascular treatment (EVT) for below-knee (BTK) lesions were enrolled in this study. Patients with acute infection requiring antibiotic therapy, chronic inflammatory disease, end-stage liver disease, malignancy were excluded from the study. Besides, patients with pre-follow-up intervention to the same vascular bed were also excluded from the study. The primary endpoint of the study was all-cause mortality. Patients were divided into two groups according to mortality. RESULTS A total of 70 patients (40.6%) died during 32 ± 21 months of follow-up in the present study. The major amputation rate was 21.5%. The mortality (+) group was older and had higher rates of congestive heart failure, chronic kidney disease, history of stroke, and CRP levels. Moreover, statin and ACE inhibitor/angiotensin receptor blocker (ACE/ARB) use, GFR, and albumin levels were lower in the mortality (+) group. CAR was significantly higher in the mortality (+) group when comparing both groups (3.25 [1.46 - 7.86] vs. 9.75 [4.5 - 17.71], p < 0.001). CAR, congestive heart failure, chronic kidney disease, history of stroke, ACE/ARB, or statin use were independent predictors of all-cause mortality in multivariable Cox regression analysis. CONCLUSIONS CAR was associated with mortality in CLTI patients undergoing EVT for BTK lesions. CAR may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.
Collapse
Affiliation(s)
- Cafer Panç
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
| | - Arda Güler
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - İsmail Gürbak
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ömer Taşbulak
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ali Kemal Kalkan
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Arif Yalçın
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Ertürk
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
12
|
Günay AE, Ekici M. Relationship Between Neutrophil/Albumin Ratio and Early Mortality After Major Lower Extremity Amputation. Cureus 2021; 13:e17733. [PMID: 34659947 PMCID: PMC8491629 DOI: 10.7759/cureus.17733] [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] [Accepted: 09/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Diabetic foot infection is a condition that affects the patient's life, may cause limb loss, and has a high mortality. Too many parameters were used for predicting early mortality but the gold standard method wasn't described. Neutrophil lymphocyte ratio (NLR) is universally accepted as a predictive value for amputation-free survival and mortality. NLR increases due to inflammation-induced neutrophilia and lymphopenia related to cortisol-induced stress. Increasing in the neutrophil albumin ratio is expected due to decreasing albumin levels because albumin is a negative acute-phase reactant. The aim of this study is to investigate the sensitivity and value of the neutrophil albumin ratio (NAR) for early mortality after major lower extremity amputation (LEA). Methods Following the approval of the ethics committee, 87 patients who underwent major LEA between May 2018 and May 2020 were analyzed for the study. White blood cell (WBC), neutrophil, lymphocyte, C-reactive protein (CRP), creatinine, albumin, platelet, and hemoglobin values on the day prior to surgery were recorded. NLR was calculated as the ratio of neutrophil count to lymphocyte count, NAR as the ratio of neutrophil count to albumin value, CRP/albumin ratio (CAR) as the ratio of CRP value to albumin value, and platelet lymphocyte ratio (PLR) as the ratio of platelet count to lymphocyte count. Each parameter was also recorded in the postoperative second week. Results Of the patients included in the study, 52 were men (59.8%) and 35 were women (40.2%). It was determined that 29 of 87 patients (33.3%) died within the first year. The relationship between post-operative NAR value and early mortality is examined. The area under the curve was calculated as 0.873. When the cut-off value was applied as 0.265, the sensitivity was found as 88% and specificity as 76%. Conclusions Higher neutrophil/albumin ratio after lower extremity amputation was associated with early mortality after extremity amputation. This parameter can help predict mortality. The cut-off value was determined as 0.265, the sensitivity was found as 88%, and specificity as 76%.
Collapse
Affiliation(s)
- Ali Eray Günay
- Orthopaedics and Traumatology, Kayseri City Education and Research Hospital, Kayseri, TUR
| | - Mehmet Ekici
- Orthopaedics and Traumatology, Kayseri City Education and Research Hospital, Kayseri, TUR
| |
Collapse
|
13
|
Süleymanoğlu M, Burak C, Gümüşdağ A, Çap M, Şenol A, Hamideyin Ş, Güzel E, Rencüzoğulları İ, Karabağ Y, Çağdaş M. Prognostic value of C-reactive protein to albumin ratio for long-term outcomes of patients with peripheral arterial disease underwent endovascular treatment. Vascular 2021; 30:481-489. [PMID: 34112027 DOI: 10.1177/17085381211025172] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is part of the systemic atherosclerotic process that is highly associated with cardiovascular diseases. Despite successful endovascular treatment (EVT) strategies, mortality and morbidity rates still remain higher in PAD patients. C-reactive protein (CRP) and albumin are biomarkers of inflammation and malnutrition that play key roles in the progression of peripheral arterial disease. In this study, we aimed to investigate the relationship between CRP-to-albumin ratio (CAR) and mortality and amputation-free survival in patients with PAD after successful EVT. METHOD Our study enrolled 149 consecutive patients who underwent EVT on atherosclerotic obstruction of iliac, femoral, popliteal and/or below-knee arteries with the clinical features of PAD and/or chronic limb-threatening ischaemia between January 2015 and January 2020. Clinical and prognostic follow-up of patients had been done at the outpatient clinic and were collected from institution's medical records. RESULTS The mean follow-up period was 22 months (14-40). All-cause mortality and amputation rates of patients in the high CAR group were significantly higher than those in the low CAR group (21.3% vs. 6.8% and 18.7% vs. 5.4%, respectively). Kaplan-Meier survival analysis showed significantly better survival for patients in the low CAR group (log-rank p = 0.0058). In multivariate logistic regression analysis, CAR was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. ROC curve analysis revealed the optimal cut-off value of CAR for predicting all-cause mortality and amputation to be >1.476 with a sensitivity of 48.5% and specificity of 94.0%. CONCLUSION The inflammatory state reflected by CAR levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, CAR was found to be an independent predictor of these clinical outcomes after adjusting for other clinically associated parameters.
Collapse
Affiliation(s)
| | - Cengiz Burak
- Department of Cardiology, Medical Faculty, M.D. Kafkas University, Kars, Turkey
| | - Ayça Gümüşdağ
- Department of Cardiology, Medical Faculty, M.D. Kafkas University, Kars, Turkey
| | - Murat Çap
- Department of Cardiology, M.D. University of Health Sciences, 226851Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ayhan Şenol
- Department of Radiology, M.D. University of Health Sciences, 226851Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Şerif Hamideyin
- Department of Cardiology, Medical Faculty, M.D. Kafkas University, Kars, Turkey
| | - Ezgi Güzel
- Department of Cardiology, Medical Faculty, M.D. Kafkas University, Kars, Turkey
| | | | - Yavuz Karabağ
- Department of Cardiology, Medical Faculty, M.D. Kafkas University, Kars, Turkey
| | - Metin Çağdaş
- Department of Cardiology, Medical Faculty, M.D. Kafkas University, Kars, Turkey
| |
Collapse
|
14
|
Cerşit S, Öcal L, Keskin M, Gürsoy MO, Kalçik M, Bayam E, Karaduman A, Uysal S, Uslu A, Küp A, Dereli S, Arslantaş U, Türkmen MM. Association of C-Reactive Protein-to-Albumin Ratio With the Presence and Progression of Abdominal Aortic Aneurysm. Angiology 2020; 72:153-158. [PMID: 32911951 DOI: 10.1177/0003319720954084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aortic dilatation due to inflammation may lead to an increase in C-reactive protein (CRP) levels. We investigated the possible relationship between CRP-to-albumin ratio (CAR) and presence and progression of abdominal aortic aneurysms (AAAs). The study included 150 patients previously diagnosed with AAA (diameter 40-54 mm) and 100 normal controls. Clinical and laboratory parameters and maximal cross-sectional AAA diameters (measured by computed tomography angiography) were obtained from all participants at baseline assessment as well as after 1 year for those with an AAA. The patients with AAA had significantly higher serum CAR compared with controls at baseline (P < .001). Increased serum CAR was found to be an independent predictor of the presence of AAA (odds ratio: 3.162, 95% CI: 1.690-5.126, P = .001) after multivariate logistic regression analysis. There was a significant increase in aortic diameter and CAR after 1 year in the patients with AAA (P < .001; P = .003); a significant correlation was found between changes in the diameter of AAAs and CAR (r = 0.414; P = .005). Serum CAR may be useful as an inflammatory biomarker for the presence and progression of AAA.
Collapse
Affiliation(s)
- Sinan Cerşit
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Lutfi Öcal
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Health Sciences University, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Macit Kalçik
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Karaduman
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Küp
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Seçkin Dereli
- Department of Cardiology, Ordu University School of Medicine, Ordu, Turkey
| | - Uğur Arslantaş
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Muhsin Türkmen
- Department of Cardiology, Health Sciences University, 111350Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|