RESUMEN
The aim of this study was to compare the levels of Galectin-3 (Gal-3) in heart failure patients at admission and discharge, and to evaluate the ability of Gal-3 at admission in predicting in-hospital mortality. A total of 111 patients were enrolled. Gal-3 and B-type natriuretic peptide (BNP) levels were measured at admission and discharge. Receiver operating characteristic analysis was used to determine the optimal cutoff values for Gal-3 and BNP, and logistic regression was used to assess the predictive ability of these biomarkers for in-hospital mortality. Gal-3 levels at discharge (24.08â ±â 9.55) were significantly lower than those at admission (30.71â ±â 11.22). The majority of patients (72.07%) experienced a decrease in Gal-3 levels, with a median reduction of 19.9% (interquartile range [IQR] 8.7-29.8). Gal-3 levels showed a weak correlation with BNP levels both at admission and discharge. Combining Gal-3 and BNP significantly improved the ability to predict in-hospital mortality, and including heart failure stage as a third predictor further improved the predictive accuracy. The optimal cutoff values for Gal-3 and BNP to predict in-hospital mortality were identified as 28.1 ng/mL and 1782.6 pg/mL, respectively, with moderate to good sensitivity and specificity. A median reduction of 19.9% of Gal-3 may indicate possibility to discharge. Our findings suggest that Gal-3 and BNP, when combined with heart failure stage, may be useful for predicting in-hospital mortality.
Asunto(s)
Insuficiencia Cardíaca , Alta del Paciente , Humanos , Pronóstico , Galectina 3 , Mortalidad Hospitalaria , Péptido Natriurético Encefálico/análisis , Valor Predictivo de las Pruebas , BiomarcadoresRESUMEN
BACKGROUND: Due to the increasing demand for kidney transplants, sometimes donors with underlying medical conditions can be considered for living kidney donor transplant. Thalassemia is amongst the most common inherited disorders of hemoglobin globally, which is not restricted as an exclusion criterion. However, there is currently no study examine the safety and characteristics of kidney donors with thalassemia minor. METHODS: All eligible live kidney donors between 2016 and 2019 with thalassemia minor at a tertiary hospital were recruited. Baseline characteristics, clinical and laboratory outcomes were investigated. RESULTS: Fifteen donors (11 women, 55.5 ± 15.0 year-old) were included with a follow-up duration of 2 (1-4) years since operation. The most prevalent gene mutation among participants was DEL-SEA. No clinical manifestations of anemia were seen but 10 participants had mild anemia diagnosed from blood tests. Cardiovascular, liver and renal function were normal before nephrectomy. Until now, all donors are alive and maintain overall good health. Anemia condition is not affected, and the post-donation eGFR = 71.04 ± 11.54 mL/min/1.73m2 is comparable to outcomes of healthy donors reported in previous studies. Two donors are at risk of proteinuria at 1-year post-transplant with A/C ratio > 30 mg/g. CONCLUSIONS: Thalassemia minor individuals who are non-transfusion-dependent, without anemia clinical manifestations and have no contraindications to kidney donation are safe to be donors in short-term. An eGFR of at least 80 mL/min/1.73m2 should be considered to avoid low post-donation eGFR, and awareness should be raised on thalassemia donors with even mild albuminuria. Nephrectomy does not worsen thalassemia.
Asunto(s)
Selección de Donante , Trasplante de Riñón , Talasemia beta , Adulto , Femenino , Humanos , Donadores Vivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Talasemia beta/diagnósticoRESUMEN
RATIONALE: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening condition of antiphospholipid syndrome (APS). Treatment and management of CAPS remain challenging and the mortality rate is approximately 50% among cases. We describe a successfully treated case of a CAPS patient who had undergone massive bowel resection due to obstruction of superior mesenteric artery. PATIENT CONCERNS: A 40-year-old male patient was admitted to our hospital with acute abdominal pain, melena, and a history of deep vein thrombosis in both legs for over 10 years, there was no previous diagnosis of APS. DIAGNOSIS: The patient was diagnosed as CAPS with bowel necrosis due to obstruction of superior mesenteric artery based on the presence of antiphospholipid antibodies, computed tomography scan, and histopathological examination. INTERVENTIONS: Emergency surgery was performed to remove approximately 6âmeters of the necrotic small intestine, of which the length of the remaining small intestine was 40 cm from the duodenum and 80âcm from the ileocaecal valve. Anticoagulants were prescribed with low molecular weight heparin. After discharging, APS was managed with direct oral anticoagulants (DOACs) for secondary thromboprophylaxis because the patient was unable to reach target International Normalized Ratio (INR) with vitamin K antagonists (VKAs). OUTCOMES: During 24 months of follow-up until now, the patient did not develop new thrombosis or relapse CAPS and his state remained stable. LESSONS: While VKAs is amongst the most important and fundamental treatment, physicians should be aware that VKAs are absorbed via the small intestine. For CAPS cases who had undergone massive bowel resection, DOACs is a reasonable alternative which has been found to be as safe and effective as VKAs in terms of thrombosis prevention.
Asunto(s)
Anticoagulantes/uso terapéutico , Síndrome Antifosfolípido/tratamiento farmacológico , Dolor Abdominal/etiología , Administración Oral , Adulto , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Masculino , Melena/etiología , Trombosis/tratamiento farmacológico , Trombosis/prevención & control , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Early detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. This study aimed to evaluate the validity of CHr and %Hypo in screening IDA among ESRD patients and compare their performance with screening IDA among non-ESRD patients. METHOD: A retrospective analysis of 312 participants was conducted at Cho Ray Hospital, Vietnam, including healthy control participants and ESRD patients. Receiver operator characteristics curves and the area under the curve (AUC) of models were used to evaluate the performance of CHr, %Hypo. Optimal cut-off values were determined using Youden's index. RESULTS: Detecting IDA in ESRD patients is more complicated, as the screening performance of CHr and %Hypo in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with AUC = 0.748 (95% CI: 0.656-0.840, power = 0.997) and 0.740 (95% CI: 0.647-0.833, power = 0.996), respectively. Cut-off values of CHr < 31.5 pg and %Hypo> 10.0 pg are recommended to obtain optimal screening ability for Vietnamese ESRD patients. CONCLUSION: CHr and %Hypo appears to be useful tools for screening IDA among both non ESRD and ESRD patients. The low cost and accessible of the two markers encourage their utility as effective screening tools in clinical practice.