RESUMO
BACKGROUND AND OBJECTIVE: The DNA load of EBV may play a part in CLL pathogenesis and prognosis. The objective of this cross-sectional study was to examine the prognostic value of EBV viral load in CLL patients in comparison with other common laboratory prognostic factors. MATERIALS AND METHODS: Whole blood and sera from forty untreated CLL patients were collected. Next, DNA was extracted from total white blood cells (WBC), and TaqMan real-time PCR was performed to determine the EBV-DNA load by amplifying a specific fragment in the BNRF1 gene. In addition, parameters such as complete blood counts (CBC) and lactate dehydrogenase (LDH) were determined using an automated clinical laboratory analyzer. RESULTS: Twenty-one patients (52.5%) were positive for EBV by real-time PCR analysis (ranged 20 to 30000 copies/µL). The difference in LDH mean levels between EBV positive and negative patients was marginally significant (P = 0.05). Furthermore, platelet (PLT) count (P = 0.03) and CD5+/CD19+ count (P = 0.04), between EBV positive and negative subgroups, were substantially different. In addition, individuals with a severe form of illness, as defined by an increase in LDH, a decrease in PLT, and an 11q deletion, had considerably higher EBV-DNA copy numbers (the ranges of viral loads were 9966.66 ± 20033 in the severe form vs. 137.13 ± 245.41 in the mild form). CONCLUSION: The EBV-DNA load could be used as a prognostic factor in the initial examination of CLL patients to better characterize the disease outcome and prognosis.
Assuntos
DNA Viral , Herpesvirus Humano 4 , Leucemia Linfocítica Crônica de Células B , Carga Viral , Humanos , Leucemia Linfocítica Crônica de Células B/sangue , Leucemia Linfocítica Crônica de Células B/genética , Leucemia Linfocítica Crônica de Células B/virologia , Herpesvirus Humano 4/genética , Masculino , Feminino , Pessoa de Meia-Idade , Prognóstico , Idoso , DNA Viral/sangue , DNA Viral/genética , Leucócitos/virologia , Infecções por Vírus Epstein-Barr/sangue , Infecções por Vírus Epstein-Barr/virologia , Infecções por Vírus Epstein-Barr/genética , Estudos Transversais , Adulto , Idoso de 80 Anos ou mais , Reação em Cadeia da Polimerase em Tempo Real , L-Lactato Desidrogenase/sangueRESUMO
Objective: To analyze MRI and clinical characteristics of idiopathic inflammatory myopathy (IIM) activity and construct a prediction model. Methods: A retrospective analysis was conducted on 326 patients with IIM from December 2019 to December 2023 at General Hospital of Ningxia Medical University, including 112 males and 214 females, aged(53.7±15.3) years. According to histopathology and electromyography, they were divided into active phase group(n=86) and inactive phase group (n=240). The two groups were randomly divided into the training set and the verification set according to the ratio of 7â¶3. The single factor analysis, least absolute shrinkage and selection operator (Lasso), random forest algorithm, and multivariate logistic regression model were used to screen the risk factors of IIM activity and construct a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the performance of prediction model. Results: There were significant differences in gender, age, T1 value, T2 value, creatine kinase-MB(CKMB), creatine kinase (CK) and lactate dehydrogenase (LDH) between the two groups(all P<0.05). Lasso and random forest algorithm screened 5 variables for analysis, age (λ=-0.009), T2 value (λ=-2.564), CKMB (λ=-0.256), CK (λ=-0.492), LDH (λ=-2.786) respectively. Multivariate logistic regression model showed that age (OR=1.603, 95%CI: 1.030-1.096), T2(OR=352.269, 95%CI: 13.303-9 328.053), CKMB (OR=2.470, 95%CI: 1.497-4.075), CK(OR=4.973, 95%CI: 2.583-9.575), LDH(OR=1 155.247, 95%CI: 152.387-8 757.954) were risk factors for active IIM patients. A prediction model nomograms were drawn with the above risk factors included. The area under the ROC curve (AUC) of the prediction model for the training set MRI combined with clinical indicators was higher than that of the clinical indicator model [0.914 (95%CI: 0.873-0.955) vs 0.901 (95%CI: 0.858-0.945), P<0.001], with sensitivity of 88.3% and 90.7%, and specificity of 81.7% and 75.0%, respectively. The AUC of the prediction model for the validation set MRI combined with clinical indicators was higher than that of the clinical model [0.982 (95%CI: 0.873-0.955) vs 0.934 (95%CI: 0.858-0.945), P<0.001], with sensitivity of 97.2% and 88.5%, and specificity of 100.0% and 92.3%, respectively. The calibration curves plotted in the training set and test set, respectively, fit well with the ideal curve. Conclusion: The nomogram model of MRI combined with clinical indicators can effectively predict the activity of IIM.
Assuntos
Imageamento por Ressonância Magnética , Miosite , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Miosite/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Estudos Retrospectivos , Fatores de Risco , Adulto , Curva ROC , Modelos Logísticos , Algoritmos , L-Lactato Desidrogenase/sangue , Idoso , EletromiografiaRESUMO
INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is a potentially life-threatening complication of cirrhotic ascites. Early diagnosis and treatment of SBP are essential to improve the survival rates and prognosis of patients. We aimed to identify the predictors of SBP to establish a new noninvasive early diagnostic tool. METHODS: We screened 1618 patients who underwent paracentesis due to cirrhotic ascites between January 2017 and December 2018 in three hospitals. We evaluated the symptomatic, clinical, and laboratory parameters to identify the predictors of SBP. The primary diagnostic model was displayed as a nomogram. RESULTS: The model included abdominal pain, diarrhea, white blood cell count, neutrophil percentage, procalcitonin, C-reactive protein, lactate dehydrogenase, glucose, and Model for End-stage Liver Disease score. The model's diagnostic performance was good, with an AUC of 0.84 [95% confidence interval (CI), 0.81-0.87] in the training cohort. In the validation cohort, the diagnostic ability was also good, with AUCs of 0.87 (95% CI, 0.83-0.91) and 0.90 (95% CI, 0.87-0.94) for inner and outer validation queues, respectively. Moreover, the decision curve analysis confirmed the clinical utility of the nomogram model. In addition, we developed a Microsoft Excel calculation model to allow convenient adoption of the model in clinical practice. CONCLUSION: We developed good performing diagnostic models for SBP.
Assuntos
Ascite , Infecções Bacterianas , Cirrose Hepática , Nomogramas , Paracentese , Peritonite , Humanos , Peritonite/microbiologia , Peritonite/diagnóstico , Cirrose Hepática/complicações , Feminino , Masculino , Ascite/microbiologia , Ascite/etiologia , Pessoa de Meia-Idade , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/complicações , Contagem de Leucócitos , Idoso , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Pró-Calcitonina/sangue , Dor Abdominal/etiologia , L-Lactato Desidrogenase/sangue , Estudos Retrospectivos , Diarreia/microbiologia , Diarreia/diagnóstico , Diarreia/complicações , Biomarcadores/sangue , Valor Preditivo dos Testes , Neutrófilos , Glicemia/metabolismo , Glicemia/análise , Área Sob a Curva , Diagnóstico PrecoceRESUMO
BACKGROUND: At the beginning of December 2022, the Chinese government made major adjustments to the epidemic prevention and control measures. The epidemic infection data and laboratory makers for infected patients based on this period may help with the management and prognostication of COVID-19 patients. METHODS: The COVID-19 patients hospitalized during December 2022 were enrolled. Logistic regression analysis was used to screen significant factors associated with mortality in patients with COVID-19. Candidate variables were screened by LASSO and stepwise logistic regression methods and were used to construct logistic regression as the prognostic model. The performance of the models was evaluated by discrimination, calibration, and net benefit. RESULTS: 888 patients were eligible, consisting of 715 survivors and 173 all-cause deaths. Factors significantly associated with mortality in COVID-19 patients were: lactate dehydrogenase (LDH), albumin (ALB), procalcitonin (PCT), age, smoking history, malignancy history, high density lipoprotein cholesterol (HDL-C), lactate, vaccine status and urea. 335 of the 888 eligible patients were defined as ICU cases. Seven predictors, including neutrophil to lymphocyte ratio, D-dimer, PCT, C-reactive protein, ALB, bicarbonate, and LDH, were finally selected to establish the prognostic model and generate a nomogram. The area under the curve of the receiver operating curve in the training and validation cohorts were respectively 0.842 and 0.853. In terms of calibration, predicted probabilities and observed proportions displayed high agreements. Decision curve analysis showed high clinical net benefit in the risk threshold of 0.10-0.85. A cutoff value of 81.220 was determined to predict the outcome of COVID-19 patients via this nomogram. CONCLUSIONS: The laboratory model established in this study showed high discrimination, calibration, and net benefit. It may be used for early identification of severe patients with COVID-19.
Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/sangue , COVID-19/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Prognóstico , China/epidemiologia , Idoso , L-Lactato Desidrogenase/sangue , Modelos Logísticos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Adulto , Pró-Calcitonina/sangue , Biomarcadores/sangue , Nomogramas , Curva ROC , Fatores de RiscoRESUMO
Background: Natural killer (NK) cells are proposed to participate in coronary artery disease (CAD) development. However, little is known about how CAD patients' NK cells respond to different stimulatory factors in terms of proliferation capability. Methods and results: Twenty-nine CAD patients' peripheral blood NK cells were isolated and individually treated with IL-2, IL-12, IL-15, IL-18, IL-21, cortisone acetate, hydrocortisone, or ascorbic acid for 36 hours, followed by cell cycle analysis using flow cytometry. The ratio of S and G2/M phase cell number to total cell number was defined as a proliferation index (PrI) and used for proliferative capability indication. The results showed that these eight factors resulted in different life cycle changes in the 29 NK cell samples. Remarkably, 28 out of 29 NK cell samples showed an obvious increase in PrI upon ascorbic acid treatment. The serum lactate dehydrogenase (LDH) level of the 29 CAD patients was measured. The results showed a negative correlation between serum LDH level and the CAD patients' NK cell PrI upon stimulation of interleukins, but not the non-interleukin stimulators. Consistently, a retrospective analysis of 46 CAD patients and 32 healthy donors showed that the circulating NK cell number negatively correlated with the serum LDH level in CAD patients. Unexpectedly, addition of LDH to NK cells significantly enhanced the production of IFN-γ, IL-10 and TNF-α, suggesting a strong regulatory role on NK cell's function. Conclusion: Ascorbic acid could promote the proliferation of the CAD patients' NK cells; LDH serum level may function as an indicator for NK cell proliferation capability and an immune-regulatory factor.
Assuntos
Proliferação de Células , Doença da Artéria Coronariana , Citocinas , Células Matadoras Naturais , L-Lactato Desidrogenase , Humanos , Células Matadoras Naturais/imunologia , Doença da Artéria Coronariana/imunologia , Doença da Artéria Coronariana/sangue , Masculino , Feminino , Pessoa de Meia-Idade , L-Lactato Desidrogenase/sangue , Idoso , Células CultivadasRESUMO
This study by Zuo et al. (2024) investigates the prognostic significance of C-reactive protein (CRP) levels, the prognostic nutritional index (PNI), and the lactate dehydrogenase-to-lymphocyte ratio (LLR) in primary central nervous system lymphoma (PCNSL) using data from 223 patients. The research demonstrates that these markers are critical in predicting patient outcomes, offering novel insights beyond traditional prognostic models like the MSKCC and IELSG scores. Despite its strengths, the study's retrospective design and lack of validation cohort limit its generalizability. Future research should focus on validating these findings in diverse, multicenter settings and integrating these markers with existing prognostic models to improve clinical decision-making. Longitudinal studies and advanced statistical methods are recommended to further explore the interactions between these factors and their impact on patient outcomes, potentially leading to the development of targeted therapies for PCNSL.
Assuntos
Proteína C-Reativa , Neoplasias do Sistema Nervoso Central , L-Lactato Desidrogenase , Linfoma , Avaliação Nutricional , Humanos , Prognóstico , L-Lactato Desidrogenase/sangue , Proteína C-Reativa/análise , Linfócitos , Estudos RetrospectivosRESUMO
INTRODUCTION: The natural course of interstitial lung disease (ILD) in patients with systemic autoimmune rheumatic diseases (SARD) varies significantly and is linked to considerable morbidity and mortality. Therefore, effective screening is crucial for early detection of SARD-ILD. Biomarkers associated with mucin 1, Krebs von den Lungen-6 (KL-6) and carbohydrate antigen 15-3 (CA 15-3), are increased in various ILD. This study aimed to assess the diagnostic accuracy of the serum biomarker CA 15-3 as a potential screening tool for ILD in patients newly diagnosed with SARD. METHODS: Conducted as a single-center cross-sectional study, the research included newly diagnosed SARD patients consecutively examined for ILD according to the algorithm. All included patients underwent chest high-resolution CT scans (HRCT), and serum levels of CA 15-3, KL-6, and lactate dehydrogenase (LDH) were measured and correlated with other variables associated with possible ILD presence. RESULTS: Serum biomarker levels, specifically CA 15-3 and LDH, are significantly higher in ILD-positive patients (P<0.001 for both). An inverse relationship is observed between higher FVC values and lower CA 15-3 levels (Rho=-0.291, P=0.007). Similarly, higher DLCO values are associated with lower CA 15-3 levels (Rho=-0.317, P=0.003). Our findings revealed that elevated CA 15-3 levels are positively correlated with higher levels of KL-6 (Rho=0.268, P=0.01) and LDH (Rho=0.227, P=0.04). With a cut-off value of 24 U/mL, CA 15-3 showed the highest sensitivity and specificity (AUC=0.807, specificity=95.7%, sensitivity=71.1%). CA 15-3 emerged as the most significant predictor of a positive HRCT finding, accurately classifying 83% of cases. CONCLUSION: These results suggest that CA 15-3 shows promise as a valuable serum biomarker for screening SARD patients for ILD in routine clinical practice.
Assuntos
Doenças Autoimunes , Biomarcadores , Doenças Pulmonares Intersticiais , Mucina-1 , Doenças Reumáticas , Humanos , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Estudos Transversais , Feminino , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/sangue , Doenças Reumáticas/complicações , Biomarcadores/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico , Adulto , Mucina-1/sangue , Idoso , Tomografia Computadorizada por Raios X , L-Lactato Desidrogenase/sangueRESUMO
To analyze the changes in lactate dehydrogenase, creatine kinase, creatine kinase isoenzyme, high-sensitivity troponin T, N-terminal B-type natriuretic peptide precursor, homocysteine, and novel inflammatory indices (neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, systemic immune-inflammation index) before and after competitions in amateur marathon runners, and to assess the effects of myocardial injury due to acute exercise and the value of novel inflammatory indices in marathon exercise monitoring. This paper is an analytical study. Amateur athletes recruited by Beijing Hospital to participate in the 2022 Beijing Marathon and the 2023 Tianjin Marathon, and those who underwent health checkups at the Beijing Hospital Medical Checkup Center from January to June 2023 were selected as the study subjects, and 65 amateur marathon runners (41 males and 24 females) and 130 healthy controls (82 males and 48 females) were enrolled in the study according to the inclusion criteria. Peripheral blood was collected one week before, immediately after, and one week after running, and routine blood tests, cardiac enzymes, infarction markers, N-terminal B-type natriuretic peptide precursor, and homocysteine were performed to calculate the values of novel inflammatory indexes. Wilcoxon signed-rank test and Spearman's rank correlation analysis were used to compare the differences in the levels of each index between the amateur marathon population and the health checkup population, and to compare the changes and correlations of each index at the three time points in the amateur marathoners.The results showed that the neutrophil-lymphocyte ratios of the healthy physical examination population and 65 amateur marathoners 1 week before running were 1.73 (1.33, 2.16) and 1.67 (1.21, 2.16), the platelet-lymphocyte ratios were 122.75 (96.69, 155.89) and 120.86 (100.74, 154.63), and the systemic immune inflammation index was 398.62 (274.50, 538.69) and 338.41 (258.62, 485.38), etc.; on 1 week before running, immediately after running and 1 week after running, lactate dehydrogenase of 65 amateur marathon runners was 173.00(159.00, 196.50)U/L,284.00(237.50, 310.50)U/L, 183.00(165.50, 206.50)U/L, creatine kinase was 131.00(94.30, 188.20)U/L,318.00(212.00, 573.15)U/L,139.00(90.55, 202.40)U/L, creatine kinase isoenzyme was 2.50(1.76, 3.43)µg/L,6.24(4.87, 10.30)µg/L,2.73(1.57, 4.40)µg/L.In 65 amateur marathon runners, lactate dehydrogenase, creatine kinase, creatine kinase isoenzyme, high sensitivity troponin T, N-terminal B-type natriuretic peptide precursor, homocysteine, and novel inflammation markers were significantly elevated in the immediate post-run period compared with 1 week before the run, and the differences were statistically significant (Z=-7.009, Z=-6.813, Z=-6.885, Z=-7.009, Z=-7.009, Z=-6.656; P<0.05 for the above indicators).Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammatory index all showed significant positive correlation with the pre-and post-run rates of change of high-sensitivity troponin T (ρ=0.28, P=0.03;ρ=0.31, P=0.01;ρ=0.27, P=0.03); these 3 markers were also significantly and positively correlated with the pre-and post-run rates of change in a collection of myocardial-related markers such as lactate dehydrogenase, creatine kinase, creatine kinase isozymes, high-sensitivity troponin T, N-terminal B-type natriuretic peptide precursor, and homocysteine, respectively(r=0.446, P=0.039; r=0.452, P=0.033; r=0.449, P=0.036).In addition, the platelet-lymphocyte ratio was positively correlated with the pre-and post-run rates of change in creatine kinase and creatine kinase isoenzymes(ρ=0.27, P=0.03;ρ=0.28, P=0.02).In conclusion, acute myocardial injury may be triggered during marathon exercise. Changes in novel inflammatory markers were significantly associated with changes in myocardial enzymes, infarction markers, N-terminal B-type natriuretic peptide precursors, and homocysteine, which may be of value for the prediction of myocardial injury during exercise.
Assuntos
Creatina Quinase , Inflamação , Corrida de Maratona , Humanos , Masculino , Feminino , Adulto , Creatina Quinase/sangue , L-Lactato Desidrogenase/sangue , Pessoa de Meia-Idade , Estudos de Casos e Controles , Troponina T/sangue , Corrida/fisiologia , Linfócitos , Neutrófilos , Peptídeo Natriurético Encefálico/sangueRESUMO
BACKGROUND: Ginseng Radix et Rhizoma (GS) is frequently used as an adjuvant therapy for patients with heart failure (HF). Metoprolol is widely used in patients with HF. However, there is no report on the combined effects of GS and metoprolol in patients with HF. OBJECTIVE: This study investigated the combined effects of GS and metoprolol in male C57BL/6J mice with HF and the underlying mechanisms. MATERIALS AND METHODS: We utilized a mouse myocardial HF model to measure the serum levels of creatine kinase (CK) and creatine kinase-MB form (CK-MB) using an automated biochemical analyzer. Lactate dehydrogenase (LDH) and cardiac troponin (cTnT) levels were determined using enzyme-linked immunosorbent assays. Autophagy of myocardial cells was evaluated using transmission electron microscopy, and changes in signal pathway proteins related to autophagy were analyzed by Western blotting. RESULTS: GS combined with metoprolol improved heart function, reduced heart damage, and decreased serum levels of CK, CK-MB, LDH, and cTnT. The combination of GS and metoprolol decreased autophagy in myocardial cells by reducing the levels of autophagy-related proteins (LC3, p62, Beclin1, and Atg5) and increasing the ratios of p-PI3K/PI3K, p-Akt/Akt, and p-mTOR/mTOR. CONCLUSION: GS enhanced the anti-heart failure effect of metoprolol. Its mechanism of action might be related to the inhibition of autophagy mediated by the activation of the PI3K/Akt/mTOR pathway.
Assuntos
Autofagia , Insuficiência Cardíaca , Metoprolol , Camundongos Endogâmicos C57BL , Panax , Animais , Masculino , Autofagia/efeitos dos fármacos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/metabolismo , Metoprolol/farmacologia , Camundongos , Panax/química , Transdução de Sinais/efeitos dos fármacos , Doença Crônica , Rizoma/química , Modelos Animais de Doenças , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Extratos Vegetais/farmacologia , Creatina Quinase/sangue , Sinergismo Farmacológico , Creatina Quinase Forma MB/sangueRESUMO
BACKGROUND: Impaired cardiac function was suggested to be implicated in the functional recovery after ischemic stroke, but the prognostic value of cardiac biomarkers among ischemic stroke patients remains unclear. We aimed to prospectively explore the associations of serum lactate dehydrogenase (LDH), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), and plasma high-sensitivity cardiac troponin T (hs-cTnT) with adverse clinical outcomes after ischemic stroke in a large-scale cohort study. METHODS: We measured serum LDH, plasma NT-proBNP, and plasma hs-cTnT levels at baseline among 5056 ischemic stroke patients from the Minhang Stroke Cohort study. All patients were followed up at 3 months after ischemic stroke onset. The primary outcome was composite outcome of death and major disability (modified Rankin Scale [mRS] score ≥ 3) at 3 months after stroke onset, and secondary outcomes included death and ordered 7-level categorical score of the mRS. RESULTS: During 3 months of follow-up, 1584 patients developed the primary outcome. Baseline serum LDH, plasma NT-proBNP, and plasma hs-cTnT were positively associated with the risk of adverse outcomes after ischemic stroke. The multivariable-adjusted odds ratios of primary outcome for the highest versus lowest quartile of LDH, NT-proBNP, and hs-cTnT were 1.37 (95% CI 1.13-1.66; Ptrend = 0.001), 2.51 (95% CI, 2.00-3.16; Ptrend < 0.001), and 2.24 (95% CI 1.77-2.83; Ptrend < 0.001), respectively. Each SD increase of log-transformed cardiac biomarker score was associated with a 49% (95% CI 37-62%; P < 0.001) increased risk of primary outcome. Multivariable-adjusted spline regression analyses showed linear relationships between cardiac biomarkers and the risk of primary outcome (all P for linearity < 0.001). Moreover, adding LDH, NT-proBNP, hs-cTnT, or cardiac biomarker score to conventional risk factors significantly improved the risk reclassification of primary outcome after ischemic stroke (all P < 0.05). CONCLUSION: High LDH, NT-proBNP, hs-cTnT, and cardiac biomarker score were independently associated with increased risks of adverse clinical outcomes among ischemic stroke patients, suggesting that cardiac biomarkers might be potential prognostic biomarkers for ischemic stroke.
Assuntos
Biomarcadores , AVC Isquêmico , L-Lactato Desidrogenase , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Troponina T , Humanos , Masculino , Feminino , Idoso , Biomarcadores/sangue , Peptídeo Natriurético Encefálico/sangue , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico , Pessoa de Meia-Idade , Fragmentos de Peptídeos/sangue , L-Lactato Desidrogenase/sangue , Troponina T/sangue , Estudos de Coortes , Seguimentos , Prognóstico , Estudos Prospectivos , Idoso de 80 Anos ou maisRESUMO
Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, potentially life-threatening haematological disease characterised by chronic complement-mediated haemolysis with multiple clinical consequences that impair quality of life. This post hoc analysis assessed haematological and clinical responses to the first targeted complement C3 inhibitor pegcetacoplan in patients with PNH and impaired bone marrow function in the PEGASUS (NCT03500549) and PRINCE (NCT04085601) studies. For patients with impaired bone marrow function, defined herein as haemoglobin <10 g/dL and absolute neutrophil count <1.5 × 109 cells/L, normalisation of the parameters may be difficult. Indeed, 20% and 43% had normalised haemoglobin in PEGASUS and PRINCE, respectively; 60% and 57% had normalised LDH, and 40% and 29% had normalised fatigue scores. A new set of parameters was applied using changes associated with clinically meaningful improvements, namely an increase in haemoglobin to ≥2 g/dL above baseline, decrease in LDH to ≤1.5× the upper limit of normal, and an increase in fatigue scores to ≥5 points above baseline. With these new parameters, 40% and 71% of PEGASUS and PRINCE patients had improved haemoglobin; 60% and 71% had an improvement in LDH, and 60% and 43% had an improvement in fatigue scores. Thus, even patients with impaired bone marrow function may achieve clinically meaningful improvements with pegcetacoplan.
Assuntos
Medula Óssea , Hemoglobinúria Paroxística , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Medula Óssea/metabolismo , Adulto , Hemoglobinas/metabolismo , Idoso , Complemento C3/metabolismo , Resultado do Tratamento , Qualidade de Vida , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/metabolismoRESUMO
BACKGROUND: The early detection of myeloid engraftment after hematopoietic stem cell transplantation (HSCT) is of clinical importance for clinicians. In this study, we evaluated whether serum lactic dehydrogenase enzyme levels are significant predictors in the early detection of successful myeloid engraftment after HSCT. METHODS: The study included 74 patients, all of whom underwent HSCT between February 2014 and June 2020. Serum lactic dehydrogenase (LDH) enzyme and complete blood parameters were evaluated at the start of the preparation regimen, on the day of product infusion, 5 days before myeloid engraftment, on the day of myeloid engraftment, and 5 days after engraftment. RESULTS: LDH enzyme levels increased statistically significantly 5 days before myeloid engraftment (P = .005), and this increase was observed to continue on the day of engraftment, and 5 days after engraftment, but the differences between the measurements 5 days before engraftment and those on the day of engraftment, and 5 days after engraftment were statistically insignificant (P > .05). There was no significant difference in LDH enzyme levels between the measurements made at the beginning of the preparation regimen and those made on the infusion day (P > .05). CONCLUSIONS: Increased LDH enzyme levels after HSCT are associated with increased myelopoiesis in the bone marrow. The monitoring of serum LDH levels and the detection of the onset of increase in enzyme levels in patients undergoing HSCT may be predictors of engraftment.
Assuntos
Transplante de Células-Tronco Hematopoéticas , L-Lactato Desidrogenase , Humanos , Masculino , Feminino , L-Lactato Desidrogenase/sangue , Adulto , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Sobrevivência de Enxerto , Criança , Biomarcadores/sangueRESUMO
In the presence of haemolysis, the interpretation of the Lactate dehydrogenase (LDH) activity result is a major operational challenge for medical laboratories: if the origin is intravascular, then the measurement will reflect the clinical reality, but in extravascular haemolysis, the laboratory will be confronted with an artefactual increase leading to false-positive high results. The aim of our study was to evaluate the adjustment of LDH concentration results according to the haemolysis index (HI). After designed a mathematical model to correct the LDH measured as a function of the haemolysis index using a Cobas 8000 analyser (Roche diagnostics, Mannheim, Germany), LDH measurement of seventy-four duplicate samples were tested before and after exposure to extravascular haemolysis process. After in vitro haemolysis process, a significant increase haemolysis index (Man-Whitney U-Test p < 0.0001) were observed. Before process the HI median was 4 [2.0 - 6.75] and after HI median was 18 [10 - 35.75]. Without correction, LDH results showed a significant increase (p < 0.001) after haemolysis process and substantial analytical discrepancies (31/74) were observed according to TEa of CLIA. After correction, data showed no significant difference (p = 0.497) and the mathematical algorithm allowed to reduce the analytical discrepancies (2/74). If haemolysis was present in vitro, the mathematical algorithm increased the accuracy of the LDH results. However, the lack of discrimination between in vivo and in vitro haemolysis requires caution and the results should be reported only as a commentary to inform the clinician.
Assuntos
Hemólise , L-Lactato Desidrogenase , Humanos , L-Lactato Desidrogenase/sangueRESUMO
PURPOSE: Using ex vivo normothermic machine perfusion (NMP) with whole blood we assessed marginal porcine kidneys under reperfusion. The aim was to link measureable machine and clinical blood parameters with the currently used visual assessment. This could serve as a baseline for a standardized evaluation score to identify potentially transplantable kidneys in the future. METHODS: Kidneys and autologous whole blood were procured from slaughterhouse pigs (n = 33) and were perfused for 4 h using NMP. The hemodynamic parameters arterial pressure (AP), renal blood flow (RBF) and intrarenal resistance (IRR) were measured. Activity of aspartate transaminase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and lactate were assessed in blood at 0/1/2/4 h. Kidneys were grouped into "potentially transplantable" (PT) or "not transplantable" (NT) based on their overall macroscopic appearance after NMP by an experienced physician. RESULTS: PT-kidneys (n = 20) had a significantly lower IRR and higher RBF than NT-kidneys (n = 13). GGT, ALP and LDH did not differ significantly, but at 4 h, AST was significantly higher in PT-kidneys compared to NT-kidneys. Lactate levels kept increasing during NMP in NT-kidneys and were significantly higher at 1/2/4 h than in PT-kidneys. CONCLUSION: The immediately assessed macroscopic aspects of examined kidneys correlated with hemodynamic parameters, increased lactate and lower AST in this study. In the future, NMP with whole blood could be a useful tool to extend the donor pool by allowing the assessment of otherwise unknown characteristics of marginal kidneys before transplantation.
Assuntos
Hemodinâmica , Transplante de Rim , Rim , Preservação de Órgãos , Perfusão , Animais , Suínos , Rim/fisiologia , Hemodinâmica/fisiologia , Preservação de Órgãos/métodos , Aspartato Aminotransferases/sangue , L-Lactato Desidrogenase/sangue , gama-Glutamiltransferase/sangue , Circulação Renal/fisiologia , Fosfatase Alcalina/sangueRESUMO
BACKGROUND: Chest injury is an important factor regarding the prognosis of patients with polytrauma (PT), and the rapid diagnosis of chest injury is of utmost importance. Therefore, the current study focused on patients' physiology and laboratory findings to quickly identify PT patients with chest injury. METHOD: Data on 64 PT patients treated at a trauma center level I between June 2020 and August 2021 were retrospectively collected. The patients were divided into a PT group without chest injury (Group A) and a PT group including chest injury (Group B). The relationship between chest injury and the patients' baseline characteristics and biochemical markers was analyzed. RESULTS: Heart rate, respiration rate, Sequential Organ Failure Assessment (SOFA) score, glutamate oxaloacetate aminotransferase (GOT), glutamate pyruvate transaminase (GPT), creatine kinase MB (CK-MB), leucocytes, hemoglobin (Hb), platelets, urine output, lactate, and lactate dehydrogenase (LDH) in groups A and B exhibited statistically significant differences at certain time points. Multifactorial analysis showed that blood LDH levels at admission were associated with chest injury (P = 0.039, CI 95% 1.001, 1.022). CONCLUSION: LDH may be a promising indicator for screening for the presence of chest injury in patients with severe polytrauma.
Assuntos
L-Lactato Desidrogenase , Traumatismo Múltiplo , Traumatismos Torácicos , Humanos , Traumatismo Múltiplo/sangue , Traumatismo Múltiplo/diagnóstico , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Traumatismos Torácicos/sangue , Traumatismos Torácicos/diagnóstico , L-Lactato Desidrogenase/sangue , Diagnóstico Diferencial , Biomarcadores/sangue , Idoso , PrognósticoRESUMO
BACKGROUND AND OBJECTIVE: An increased risk of mortality and hospitalization was consistently demonstrated in hemodialysis (HD) patients affected by pandemic coronavirus infection (COVID-19). In this study, we analyzed parameters that may impact mortality in COVID-19 HD patients, including neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), C-reactive protein (CRP), COVID-19 disease status and telomere length in peripheral blood cells (TL). MATERIALS AND METHODS: A total of 130 chronic hemodialysis patients were enrolled and followed up for 18 months. Patients were categorized into groups based on their COVID-19 disease history and subsequent data about their survival status at the end of the study. Routine laboratory parameters were assessed using standard automated methods and TL was determined using the modified Cawthon method. Survival predictors were analyzed using Kaplan-Meier analysis. RESULTS: Deceased patients (30%) were older with higher body mass index (BMI), higher levels of LDH, NLR index, CRP and lower TL and lymphocytes count compared to survivors. Kaplan-Meier survival analysis showed six parameters were significant mortality predictors in the following order of significance: COVID-19 history, 2-years cardiovascular mortality risk score, NLR, TL, CRP, LDH. Using binary logistic regression analysis Summary risk score, a combination of these six parameters revealed as the best predictor of patient's survival in this group of parameters (log rank 25.4, p < 0.001). CONCLUSION: Compared to the general population, the mortality rate among HD patients persists at a higher level despite advancements in HD technology and patient care. The situation has been exacerbated by COVID-19, by significant increase in mortality rate among these patients.
Assuntos
Proteína C-Reativa , COVID-19 , Inflamação , Diálise Renal , Humanos , COVID-19/mortalidade , COVID-19/virologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Proteína C-Reativa/metabolismo , Linfócitos/metabolismo , Neutrófilos/metabolismo , Telômero/genética , Telômero/metabolismo , SARS-CoV-2 , L-Lactato Desidrogenase/sangue , Estimativa de Kaplan-Meier , Falência Renal Crônica/terapia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/sangueRESUMO
BACKGROUND: The Omicron variant broke out in China at the end of 2022, causing a considerable number of severe cases and even deaths. The study aimed to identify risk factors for death in patients hospitalized with SARS-CoV-2 Omicron infection and to establish a scoring system for predicting mortality. METHODS: 1817 patients were enrolled at eight hospitals in China from December 2022 to May 2023, including 815 patients in the training group and 1002 patients in the validation group. Forty-six clinical and laboratory features were screened using LASSO regression and multivariable logistic regression. RESULTS: In the training set, 730 patients were discharged and 85 patients died. In the validation set, 918 patients were discharged and 84 patients died. LASSO regression identified age, levels of interleukin (IL) -6, blood urea nitrogen (BUN), lactate dehydrogenase (LDH), and D-dimer; neutrophil count, neutrophil-to-lymphocyte ratio (NLR) as associated with mortality. Multivariable logistic regression analysis showed that older age, IL-6, BUN, LDH and D-dimer were significant independent risk factors. Based on these variables, a scoring system was developed with a sensitivity of 83.6% and a specificity of 83.5% in the training group, and a sensitivity of 79.8% and a sensitivity of 83.0% in the validation group. CONCLUSIONS: A scoring system based on age, IL-6, BUN, LDH and D-dime can help clinicians identify patients with poor prognosis early.
Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , China/epidemiologia , Idoso , Fatores de Risco , Hospitalização/estatística & dados numéricos , Adulto , Prognóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fatores Etários , Modelos Logísticos , Neutrófilos , Nitrogênio da Ureia Sanguínea , L-Lactato Desidrogenase/sangueRESUMO
Identifying individuals poised to gain from immune checkpoint inhibitor (ICI) therapies is a pivotal element in the realm of tailored healthcare. The expression level of Programmed Death Ligand 1 (PD-L1) has been linked to the response to ICI therapy, but its assessment typically requires substantial tumor tissue, which can be challenging to obtain. In contrast, blood samples are more feasible for clinical application. A number of promising peripheral biomarkers have been proposed to overcome this hurdle. This research aims to evaluate the prognostic utility of the albumin-to-lactate dehydrogenase ratio (LAR), the Pan-immune-inflammation Value (PIV), and the Prognostic Nutritional Index (PNI) in predicting the response to ICI therapy in individuals with advanced non-small cell lung cancer (NSCLC). Furthermore, the study seeks to construct a predictive nomogram that includes these markers to facilitate the selection of patients with a higher likelihood of benefiting from ICI therapy. A research initiative scrutinized the treatment records of 157 advanced NSCLC patients who received ICI therapy across two Jiangxi medical centers. The cohort from Jiangxi Provincial People's Hospital (comprising 108 patients) was utilized for the training dataset, while the contingent from Jiangxi Cancer Hospital (49 patients) served for validation purposes. Stratification was based on established LAR, PIV, and PNI benchmarks to explore associations with DCR and ORR metrics. Factorial influences on ICI treatment success were discerned through univariate and multivariate Cox regression analysis. Subsequently, a Nomogram was devised to forecast outcomes, its precision gauged by ROC and calibration curves, DCA analysis, and cross-institutional validation. In the training group, the optimal threshold values for LAR, PIV, and PNI were identified as 5.205, 297.49, and 44.6, respectively. Based on these thresholds, LAR, PIV, and PNI were categorized into high (≥ Cut-off) and low (< Cut-off) groups. Patients with low LAR (L-LAR), low PIV (L-PIV), and high PNI (H-PNI) exhibited a higher disease control rate (DCR) (P < 0.05) and longer median progression-free survival (PFS) (P < 0.05). Cox multivariate analysis indicated that PS, malignant pleural effusion, liver metastasis, high PIV (H-PIV), and low PNI (L-PNI) were risk factors adversely affecting the efficacy of immunotherapy (P < 0.05). The Nomogram model predicted a concordance index (C-index) of 0.78 (95% CI: 0.73-0.84). The areas under the ROC curve (AUC) for the training group at 6, 9, and 12 months were 0.900, 0.869, and 0.866, respectively, while the AUCs for the external validation group at the same time points were 0.800, 0.886, and 0.801, respectively. Throughout immunotherapy, PIV and PNI could act as prospective indicators for forecasting treatment success in NSCLC patients, while the devised Nomogram model exhibits strong predictive performance for patient prognoses.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Inibidores de Checkpoint Imunológico , Imunoterapia , Inflamação , Neoplasias Pulmonares , Humanos , Carcinoma Pulmonar de Células não Pequenas/terapia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/tratamento farmacológico , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Imunoterapia/métodos , Inibidores de Checkpoint Imunológico/uso terapêutico , Prognóstico , Avaliação Nutricional , Estadiamento de Neoplasias , Nomogramas , Biomarcadores Tumorais/sangue , L-Lactato Desidrogenase/sangue , AdultoRESUMO
INTRODUCTION: Serum is the International Federation of Clinical Chemistry (IFCC)-recommended matrix for the measurement of lactate dehydrogenase (LD); however, many laboratories opt for lithium heparin plasma to achieve quicker turnaround times and minimize tube usage. When introducing the new Sigma-Strong IFCC-recommended LDH2 assay from Abbott Laboratories on lithium-heparin collected samples, we observed a rise in the patient median LD activity as well as several samples exhibiting falsely elevated values. MATERIALS AND METHODS: 120 + serum and plasma samples from consenting patients were collected and evaluated for complete blood count and lactate dehydrogenase using two different assays. Aggregated patient results before and after introduction of the LDH2 assay were compared. RESULTS: Mean LD was 14% higher in plasma than in serum when using the LDH2 assay but only 5% higher when using the previous LDH legacy assay from Abbott Laboratories. Similarly, platelets and leukocytes were 10-30 times higher in plasma than in serum. Aggregated lactate dehydrogenase patient results demonstrated a dramatic increase in patient median following introduction of the LDH2 assay. Various experiments were tried to reduce cellular interference, but the only viable solution we found, apart from reverting to the LDH legacy assay, was to utilize serum tubes. CONCLUSION: We conclude that lithium-heparin plasma leads to falsely elevated lactate dehydrogenase activity when using the LDH2 assay. These errors can be prevented by using serum collected in gel separator tubes.
Assuntos
L-Lactato Desidrogenase , Humanos , L-Lactato Desidrogenase/sangue , Plasma/química , Heparina/sangue , Soro/química , Reações Falso-PositivasRESUMO
Optimal timing for intubating patients with coronavirus disease 2019 (COVID-19) has been debated throughout the pandemic. Early use of high-flow nasal cannula (HFNC) can help reduce the need for intubation, but delay can result in poorer outcomes. This study examines trends in laboratory parameters and serum severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA levels of patients with COVID-19 in relation to HFNC failure. Patients requiring HFNC within three days of hospitalization between July 1 and September 30, 2021 were enrolled. The primary outcome was HFNC failure (early failure ≤Day 3; late failure ≥Day 4), defined as transfer to intensive care just before/after intubation or in-hospital death. We examined changes in laboratory markers and SARS-CoV2-RNAemia on Days 1, 4, and 7, together with demographic data, oxygenation status, and therapeutic agents. We conducted a univariate logistic regression with the explanatory variables defined as 10% change rate in each laboratory marker from Day 1 to 4. We utilized the log-rank test to assess the differences in HFNC failure rates, stratified based on the presence of SARS-CoV2 RNAemia. Among 122 patients, 17 (13.9%) experienced HFNC failure (early: n = 6, late: n = 11). Seventy-five patients (61.5%) showed an initial SpO2/FiO2 ratio ≤243, equivalent to PaO2/FiO2 ratio ≤200, and the initial SpO2/FiO2 ratio was significantly lower in the failure group (184 vs. 218, p = 0.018). Among the laboratory markers, a 10% increase from Day 1 to 4 of lactate dehydrogenase (LDH) and interleukin (IL)-6 was associated with late failure (Odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.09-1.89 and OR: 1.04, 95%CI: 1.00-1.19, respectively). Furthermore, in patients with persistent RNAemia on Day 4 or 7, the risk of late HFNC failure was significantly higher (Log-rank test, p<0.01). In conclusion, upward trends in LDH and IL-6 levels and the persistent RNAemia even after treatment were associated with HFNC failure.