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Wind M, Dekker L, van den Akker-van Marle ME, Ballieux BEPB, Cobbaert CM, Rabelink TJ, van Lith JMM, Teng YKO, Sueters M. The addition of the sFlt-1/PlGF ratio to the protein/creatinine ratio in multiple pregnancy: Post-hoc analysis of the PREPARE cohort study. Pregnancy Hypertens 2024; 36:101111. [PMID: 38387424 DOI: 10.1016/j.preghy.2024.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/14/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To assess the predictive accuracy of the sFlt-1/PlGF ratio cut-off 38 in addition to the standard-of-care spot urine protein/creatinine ratio (PCr) for multiple pregnancies in women with suspected pre-eclampsia. STUDY DESIGN Post-hoc analysis of a prospective cohort study. MAIN OUTCOME MEASURES Primary outcome was the occurrence of pre-eclampsia in one and four weeks after presentation with suspected pre-eclampsia. Test characteristics with 95% confidence intervals (CI) were calculated on pre-eclampsia development in one and four weeks. RESULTS Twenty-three multiple pregnancies with suspected pre-eclampsia between 20 and 37 weeks gestation were included for analysis. Women who eventually developed pre-eclampsia had a significantly higher PCr (34.0 vs. 16.5, p = 0.015), sFlt-1 (17033 vs. 5270 pg/ml, p = 0.047) and sFlt-1/PlGF ratio (99 vs. 25, p = 0.033) at baseline. Furthermore, PCr ≥ 30 and sFlt-1/PlGF ratio > 38 was respectively seen in 1/16 (6.3 %) and 3/16 (18.8 %) of the women who did not develop pre-eclampsia. For predicting pre-eclampsia within one week the sFlt-1/PlGF ratio sensitivity was 75.0 % [95 % CI 19.4-99.4] and the negative predictive value 93.8 % [73.0-98.8], while no pre-eclampsia developed when PCr was < 30. Consequently, the combination of these tests did not lead to an improvement in test characteristics, with non-significant differences in positive predictive value (50.0 % [29.5-70.5] versus 80.0 % [37.3-96.4]) compared to PCr alone for pre-eclampsia development in one week. CONCLUSIONS In addition to standard-of-care spot urine PCr measurements, this study has not been able to demonstrate that the sFlt-1/PlGF ratio cut-off 38 is of added value in the prediction of pre-eclampsia in multiple pregnancy. TRIAL REGISTRATION Netherlands Trial Register (NL8308).
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Affiliation(s)
- M Wind
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
| | - L Dekker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - B E P B Ballieux
- Department of Clinical Chemistry, Leiden University Medical Centre, Leiden, the Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Centre, Leiden, the Netherlands
| | - T J Rabelink
- Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Y K O Teng
- Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Sueters
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
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Reijnders E, van der Laarse A, Jukema JW, Cobbaert CM. High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine. Front Cardiovasc Med 2023; 10:1264319. [PMID: 37908502 PMCID: PMC10613690 DOI: 10.3389/fcvm.2023.1264319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
As time has come to translate trial results into individualized medical diagnosis and therapy, we analyzed how to minimize residual risk of cardiovascular disease (CVD) by reviewing papers on "residual cardiovascular disease risk". During this review process we found 989 papers that started off with residual CVD risk after initiating statin therapy, continued with papers on residual CVD risk after initiating therapy to increase high-density lipoprotein-cholesterol (HDL-C), followed by papers on residual CVD risk after initiating therapy to decrease triglyceride (TG) levels. Later on, papers dealing with elevated levels of lipoprotein remnants and lipoprotein(a) [Lp(a)] reported new risk factors of residual CVD risk. And as new risk factors are being discovered and new therapies are being tested, residual CVD risk will be reduced further. As we move from CVD risk reduction to improvement of patient management, a paradigm shift from a reductionistic approach towards a holistic approach is required. To that purpose, a personalized treatment dependent on the individual's CVD risk factors including lipid profile abnormalities should be configured, along the line of P5 medicine for each individual patient, i.e., with Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive approaches.
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Affiliation(s)
- E. Reijnders
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - A. van der Laarse
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - C. M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
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van Duijl TT, Soonawala D, de Fijter JW, Ruhaak LR, Cobbaert CM. Rational selection of a biomarker panel targeting unmet clinical needs in kidney injury. Clin Proteomics 2021; 18:10. [PMID: 33618665 PMCID: PMC7898424 DOI: 10.1186/s12014-021-09315-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/30/2021] [Indexed: 12/01/2022] Open
Abstract
The pipeline of biomarker translation from bench to bedside is challenging and limited biomarkers have been adopted to routine clinical care. Ideally, biomarker research and development should be driven by unmet clinical needs in health care. To guide researchers, clinical chemists and clinicians in their biomarker research, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has developed a structured questionnaire in which the clinical gaps in current clinical pathways are identified and desirable performance specifications are predefined. In kidney injury, the high prevalence of the syndrome acute kidney injury (AKI) in the hospital setting has a significant impact on morbidity, patient survival and health care costs, but the use of biomarkers indicating early kidney injury in daily patient care remains limited. Routinely, medical labs measure serum creatinine, which is a functional biomarker, insensitive for detecting early kidney damage and cannot distinguish between renal and prerenal AKI. The perceived unmet clinical needs in kidney injury were identified through the EFLM questionnaire. Nephrologists within our tertiary care hospital emphasized that biomarkers are needed for (1) early diagnosis of in-hospital AKI after a medical insult and in critically ill patients, (2) risk stratification for kidney injury prior to a scheduled (elective) intervention, (3) kidney injury monitoring in patients scheduled to receive nephrotoxic medication and after kidney transplantation and (4) differentiation between prerenal AKI and structural kidney damage. The biomarker search and selection strategy resulted in a rational selection of an eleven-protein urinary panel for kidney injury that target these clinical needs. To assess the clinical utility of the proposed biomarker panel in kidney injury, a multiplexed LC-MS test is now in development for the intended translational research.
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Affiliation(s)
- T T van Duijl
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Postzone E2-P, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - D Soonawala
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - L R Ruhaak
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Postzone E2-P, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Postzone E2-P, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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4
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Groeneveld GH, van 't Wout JW, Aarts NJ, van Rooden CJ, Verheij TJM, Cobbaert CM, Kuijper EJ, de Vries JJC, van Dissel JT. Prediction model for pneumonia in primary care patients with an acute respiratory tract infection: role of symptoms, signs, and biomarkers. BMC Infect Dis 2019; 19:976. [PMID: 31747890 PMCID: PMC6865035 DOI: 10.1186/s12879-019-4611-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care. METHODS From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model. RESULTS Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics. CONCLUSIONS Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.
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Affiliation(s)
- G H Groeneveld
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, P.O. box 9600, 2300 RC, Leiden, the Netherlands.
| | - J W van 't Wout
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, P.O. box 9600, 2300 RC, Leiden, the Netherlands
| | - N J Aarts
- Department of Radiology, HMC Bronovo, P.O. box 432, 2501 CK, The Hague, the Netherlands
| | - C J van Rooden
- Department of Radiology, HAGA hospital, P.O. box 40551, 2504 LN, The Hague, the Netherlands
| | - T J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, P.O. box 9600, 2300 RC, Leiden, the Netherlands
| | - E J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, P.O. box 9600, 2300 RC, Leiden, the Netherlands
| | - J J C de Vries
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, P.O. box 9600, 2300 RC, Leiden, the Netherlands
| | - J T van Dissel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), Bilthoven, the Netherlands.,Department of infectious diseases, Leiden University Medical Center, Leiden, the Netherlands
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Kos S, Cobbaert CM, Kuijper TM, Oostdijk W, Hannema SE, Wit JM, Biermasz N, Ballieux BEPB. IGF-1 and IGF-1 SDS - fit for purpose? Eur J Endocrinol 2019; 181:L1-L4. [PMID: 31505458 DOI: 10.1530/eje-19-0458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 11/08/2022]
Affiliation(s)
- S Kos
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, The Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - T M Kuijper
- Department of Science, Maasstad Hospital, Rotterdam, The Netherlands
| | - W Oostdijk
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - S E Hannema
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - J M Wit
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - N Biermasz
- Division of Endocrinology and Center for Endocrine Tumours, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - B E P B Ballieux
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
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6
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Bouwens JA, van Duijn E, Cobbaert CM, Roos RAC, van der Mast RC, Giltay EJ. Disease stage and plasma levels of cytokines in Huntington's disease: A 2-year follow-up study. Mov Disord 2017; 32:1103-1104. [PMID: 28556406 DOI: 10.1002/mds.26950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- J A Bouwens
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Rodersana Center for Addiction, Oirschot, The Netherlands
| | - E van Duijn
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Center for Mental Health Care Delfland, Delft, The Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Center, Leiden, The Netherlands
| | - R A C Roos
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - R C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Department of Psychiatry, CAPRI-University of Antwerp, Antwerp, Belgium
| | - E J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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7
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Jansen SW, Akintola AA, Roelfsema F, van der Spoel E, Cobbaert CM, Ballieux BE, Egri P, Kvarta-Papp Z, Gereben B, Fekete C, Slagboom PE, van der Grond J, Demeneix BA, Pijl H, Westendorp RGJ, van Heemst D. Human longevity is characterised by high thyroid stimulating hormone secretion without altered energy metabolism. Sci Rep 2015; 5:11525. [PMID: 26089239 PMCID: PMC4473605 DOI: 10.1038/srep11525] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 05/28/2015] [Indexed: 12/25/2022] Open
Abstract
Few studies have included subjects with the propensity to reach old age in good health, with the aim to disentangle mechanisms contributing to staying healthier for longer. The hypothalamic-pituitary-thyroid (HPT) axis maintains circulating levels of thyroid stimulating hormone (TSH) and thyroid hormone (TH) in an inverse relationship. Greater longevity has been associated with higher TSH and lower TH levels, but mechanisms underlying TSH/TH differences and longevity remain unknown. The HPT axis plays a pivotal role in growth, development and energy metabolism. We report that offspring of nonagenarians with at least one nonagenarian sibling have increased TSH secretion but similar bioactivity of TSH and similar TH levels compared to controls. Healthy offspring and spousal controls had similar resting metabolic rate and core body temperature. We propose that pleiotropic effects of the HPT axis may favour longevity without altering energy metabolism.
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Affiliation(s)
- S W Jansen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - A A Akintola
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Roelfsema
- Department of Medicine, Section Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands
| | - E van der Spoel
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - B E Ballieux
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Egri
- 1] Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary [2] Semmelweis University, János Szentágothai PhD School of Neurosciences, Budapest, H-1085 Hungary
| | - Z Kvarta-Papp
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - B Gereben
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - C Fekete
- 1] Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary [2] Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Tupper Research Institute, Tufts Medical Centre, Boston, MA, USA
| | - P E Slagboom
- Section of Molecular Epidemiology, Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - J van der Grond
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - B A Demeneix
- UMR 7221 CNRS / MNHN Evolution des Régulations Endocriniennes, Département Régulations, Développement et Diversité Moléculaire, Muséum National d'Histoire Naturelle, Paris, France
| | - H Pijl
- Department of Medicine, Section Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R G J Westendorp
- 1] Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands [2] Department of Public Health, University of Copenhagen, Denmark
| | - D van Heemst
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
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Hubers AAM, van der Mast RC, Pereira AM, Roos RAC, Veen LJ, Cobbaert CM, van Duijn E, Giltay EJ. Hypothalamic-pituitary-adrenal axis functioning in Huntington's disease and its association with depressive symptoms and suicidality. J Neuroendocrinol 2015; 27:234-44. [PMID: 25565388 DOI: 10.1111/jne.12255] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/10/2014] [Accepted: 01/04/2015] [Indexed: 12/27/2022]
Abstract
Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis has been reported in Huntington's disease (HD). In non-HD populations, alterations in HPA axis activity have been associated with depression and suicidality. The present study aims to compare HPA axis activity between HD mutation carriers and controls, and examine its association with depressive symptoms and suicidality. To this end, salivary cortisol concentrations at seven time points, as well as depressive symptoms and suicidality, were assessed in 49 pre-motor, 102 motor symptomatic mutation carriers and 55 controls, at baseline and follow-up combined. Differences in parameters of HPA axis activity between these three groups, and their associations with depressive symptoms and suicidality in HD mutation carriers, were analysed using multilevel regression analyses. There were no differences in parameters of HPA axis activity between mutation carriers and controls, whereas pre-motor symptomatic mutation carriers had a significantly higher area under the curve to the increase (AUCi ) compared to motor symptomatic mutation carriers. In the entire HD cohort, HPA axis activity was not associated with depressive symptoms or suicidality. After stratifying mutation carriers into pre-motor, early and advanced disease stages, β values differed between these groups. Remarkably, a higher AUCi was significantly associated with depressive symptoms in pre-motor and early disease stage mutation carriers, with a reverse nonsignificant association in advanced disease stage mutation carriers. The lower AUCi in motor symptomatic mutation carriers and the varying associations with depressive symptoms and suicidality in pre-motor, early and advanced disease stages could possibly be explained by exhaustion of the HPA axis after prolonged stress-induced HPA axis hyperactivity and deserves further longitudinal study.
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Affiliation(s)
- A A M Hubers
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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9
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Bouwens JA, Hubers AAM, van Duijn E, Cobbaert CM, Roos RAC, van der Mast RC, Giltay EJ. Acute-phase proteins in relation to neuropsychiatric symptoms and use of psychotropic medication in Huntington's disease. Eur Neuropsychopharmacol 2014; 24:1248-56. [PMID: 24957738 DOI: 10.1016/j.euroneuro.2014.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
Activation of the innate immune system has been postulated in the pathogenesis of Huntington's disease (HD). We studied serum concentrations of C-reactive protein (CRP) and low albumin as positive and negative acute-phase proteins in HD. Multivariate linear and logistic regression was used to study the association between acute-phase protein levels in relation to clinical, neuropsychiatric, cognitive, and psychotropic use characteristics in a cohort consisting of 122 HD mutation carriers and 42 controls at first biomarker measurement, and 85 HD mutation carriers and 32 controls at second biomarker measurement. Significant associations were found between acute-phase protein levels and Total Functioning Capacity (TFC) score, severity of apathy, cognitive impairment, and the use of antipsychotics. Interestingly, all significant results with neuropsychiatric symptoms disappeared after additional adjusting for antipsychotic use. High sensitivity CRP levels were highest and albumin levels were lowest in mutation carriers who continuously used antipsychotics during follow-up versus those that had never used antipsychotics (mean difference for CRP 1.4 SE mg/L; P=0.04; mean difference for albumin 3 SE g/L; P<0.001). The associations found between acute-phase proteins and TFC score, apathy, and cognitive impairment could mainly be attributed to the use of antipsychotics. This study provides evidence that HD mutation carriers who use antipsychotics are prone to develop an acute-phase response.
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Affiliation(s)
- J A Bouwens
- Department of Psychiatry, Leiden University Medical Center, The Netherlands.
| | - A A M Hubers
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
| | - E van Duijn
- Department of Psychiatry, Leiden University Medical Center, The Netherlands; Center for Mental Health Care Delfland, Delft, The Netherlands
| | - C M Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Center, The Netherlands
| | - R A C Roos
- Department of Neurology, Leiden University Medical Center, The Netherlands
| | - R C van der Mast
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
| | - E J Giltay
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
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Cobbaert CM, Delanghe J, Boer JMA, Feskens EJM. Regional differences of HFE (C282Y, H63D) allele frequencies in the Netherlands A model case illustrating the significance of genographics and prehistorical population migration. Acta Clin Belg 2013; 67:430-5. [PMID: 23340149 DOI: 10.2143/acb.67.6.2062708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated HFE C282Y and H63D allele frequencies in three Dutch towns in the Netherlands, as well as their association with cardiovascular disease (CVD) mortality. Study subjects were selected from participants of the Monitoring Project on Cardiovascular Disease Risk Factors in the Netherlands carried out in Amsterdam, Doetinchem and Maastricht among > 35000 subjects, 20-59 years of age. Mortality follow-up lasted 9 to 13 years. A random sample of the cohort (n = 1075) provided information on the total study population. The random sample and all CVD deaths (n = 301) were genotyped for the C282Y and H63D mutation. Adjusted hazard ratios (HR) for CVD mortality were calculated per genotype. C282Y allele frequencies differed significantly between the towns investigated (p = 0.017), whereas the allele frequencies of H63D were similar (p = 0.141) across towns. In Maastricht we found a C282Y allele frequency of 0.086 compared to 0.055 in Amsterdam and 0.054 in Doetinchem. C282Y and H63D heterozygosity did not predict fatal CVD in either men or women, whereas homozygosity for the H63D mutation increased fatal CVD in women (adjusted HR = 8.5; 95% CI = 2.3-31.1). The unexpected high C282Y allele frequency in Maastricht is in line with the recent evidence of a Celtic origin of citizens from the former southern Netherlands and with prehistorical population migrations revealed in the context of the international Genographic Project, a landmark study of prehistorical human migrations around the globe. We recommend that when designing national screening programmes and national registries for genetic disorders, potential regional prevalence differences should be taken into account.
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Affiliation(s)
- C M Cobbaert
- Department of Clinical Chemistry, Leiden University Hospital, The Netherlands.
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11
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van der Burg-de Graauw N, Cobbaert CM, Middelhoff CJFM, Bantje TA, van Guldener C. The additive value of N-terminal pro-B-type natriuretic peptide testing at the emergency department in patients with acute dyspnoea. Eur J Intern Med 2009; 20:301-6. [PMID: 19393498 DOI: 10.1016/j.ejim.2008.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 08/29/2008] [Accepted: 09/24/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) and its inactive counterpart NT-proBNP can help to identify or rule out heart failure in patients presenting with acute dyspnoea. It is not well known whether measurement of these peptides can be omitted in certain patient groups. METHODS We conducted a prospective observational study of 221 patients presenting with acute dyspnoea at the emergency department. The attending physicians estimated the probability of heart failure by clinical judgement. NT-proBNP was measured, but not reported. An independent panel made a final diagnosis of all available data including NT-proBNP level and judged whether and how NT-proBNP would have altered patient management. RESULTS NT-proBNP levels were highest in patients with heart failure, alone or in combination with pulmonary failure. Additive value of NT-proBNP was present in 40 of 221 (18%) of the patients, and it mostly indicated that a more intensive treatment for heart failure would have been needed. Clinical judgement was an independent predictor of additive value of NT-proBNP with a maximum at a clinical probability of heart failure of 36%. CONCLUSION NT-proBNP measurement has additive value in a substantial number of patients presenting with acute dyspnoea, but can possibly be omitted in patients with a clinical probability of heart failure of >70%.
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12
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Cobbaert CM, Weykamp CW, Michielsen ECHJ, Baadenhuijsen H, van Dieijen-Visser MP. Time-Dependent Instability of Cardiac Troponins in Human Plasma Spiked with NIST Reference Material 2921. Clin Chem 2008; 54:2078-9. [DOI: 10.1373/clinchem.2008.104182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- C M Cobbaert
- Department of Clinical Chemistry Amphia Hospital Breda, the Netherlands
| | - C W Weykamp
- Department of Clinical Chemistry Queen Beatrix Hospital, Winterswijk the Netherlands
| | - E C H J Michielsen
- Department of Clinical Chemistry University Hospital Maastricht the Netherlands
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van Gammeren AJ, Cobbaert CM, Schrauwen CJM, Voets MAJ, Ermens AAM. Fresh frozen plasma transfusion for reversal of prolonged post-anaesthesia apnoea. Transfus Med 2008; 18:134-6. [DOI: 10.1111/j.1365-3148.2008.00851.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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ten Kate-Booij MJ, van Guldener C, Cobbaert CM. [Anejaculation caused by haemosiderosis: male infertility in hereditary haemochromatosis]. Ned Tijdschr Geneeskd 2007; 151:1105-8. [PMID: 17557664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A couple was investigated for subfertility. Haemochromatosis was suspected when the 36-year-old man had failure of ejaculation, fatigue and limited facial hair growth. Haemochromatosis was confirmed by an iron saturation of 102% (normal range: 20-45), a highly elevated serum ferritin concentration of 5468 mg/1l (normal range: 18-280) and highly elevated liver enzymes. Molecular genetics showed homozygous C282Y mutation of the HFE gene. Due to consequent venesection therapy, levels of ferritin and transferrin decreased and liver enzymes normalized. However luteinizing hormone and follicle stimulating hormone failed to increase to normal levels. Treatment with gonadotropins was then applied, which corrected ejaculation and semen characteristics. His partner failed to become pregnant with ovulation stimulation and intrauterine inseminations. After two unsuccessful IVF procedures she became pregnant in the third procedure. Haemochromatosis should be considered and iron studies performed if subfertility due to an endocrine disorder is being investigated. Deposition in the pituitary or the gonads of the HFE-mutated patients leads to hypogonadism. Most of the patients with C282Y mutation are homozygous (85-90%), but the majority of the carriers will not develop the disease. Deficiency of hepcidin, an important regulator for the iron metabolism, was suspected in our patient, based on the early onset of his disease and the low serum levels of hepcidin. The age at diagnosis and the start of venesections is critical for reversal of organ damage. Aggressive venesection can restore hypothalamic-pituitary-gonadal function, preventing further organ damage. But with increasing disease progression venesection will not restore azoospermia or the failure to ejaculate.
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Cobbaert CM, Luderer TK. Total error evaluation of Roche direct HDL-cholesterol reagent and calibrator across 31 lot combinations: a 2-year experience. Clin Chem 2000; 46:133-4. [PMID: 10620588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Griffioen PH, Zwang L, van Schaik RH, Engel H, Lindemans J, Cobbaert CM. Optimization of apolipoprotein(a) genotyping with pulsed field gel electrophoresis. Clin Chem 1999; 45:771-6. [PMID: 10351984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Increased lipoprotein(a) is a risk factor for atherosclerosis, and its concentration in serum is inversely correlated with the size of the apoliprotein(a) [apo(a)] component. The size of the apo(a) gene is determined mainly by the Kringle IV size polymorphism. We have optimized and characterized pulsed field gel electrophoresis (PFGE) for apo(a) genotyping. METHODS Established PFGE protocols were adjusted. The changes included the following: (a) increased DNA yields by the use of all leukocytes for isolation from either 3 mL of fresh EDTA whole blood or 250 microL of frozen buffy coats; (b) increased efficiency of Kpn1 digestion by the inclusion of a digestion buffer wash; (c) reduction of assay time by the use of capillary blotting; (d) increased sensitivity by the use of four digoxigenin-labeled apo(a) probes; and (e) identification using a single film by the inclusion of a digoxigenin-labeled lambda marker probe in addition to apo(a) probes in the hybridization mix. RESULTS In older Caucasians, 93% (buffy coats, n=468) were heterozygous for apo(a) gene size. An inverse correlation between serum lipoprotein(a) and the sum of Kringle IV alleles was found (y = -23x + 1553; r = -0.442; n = 468). Gel-to-gel variation was minimal (3%). Imprecision (SD) was one Kringle IV repeat (control sample containing eight fragments of 72-233 kb; n=34 electrophoretic runs). CONCLUSIONS The practicality and sensitivity of the apo(a) genotyping technique by PFGE were improved, and accuracy and reproducibility were preserved. The optimized procedure is promising for apo(a) genotyping on frozen buffy coats from large epidemiological studies.
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Affiliation(s)
- P H Griffioen
- University Hospital Rotterdam Dijkzigt, Department of Clinical Chemistry, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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