Could an analysis of mean corpuscular volume help to improve risk stratification in non-anemic patients with acute myocardial infarction?

BACKGROUND: Nowadays, when the majority of patients with acute myocardial infarction (AMI) are treated with primary percutaneous coronary intervention and modern pharmacotherapy, risk stratification becomes a challenge. Simple and easily accessible parameters that would help in a better determination of prognosis are needed. The aim of the study was to estimate the prevalence of high mean corpuscular volume (MCV, defined as MCV > 92 fL) and to establish its prognostic value in non-anemic patients with AMI. METHODS: We retrospectively analyzed the data of 248 consecutive non-anemic patients hospitalized due to AMI (median age: 65 [59-76] years, men: 63%, ST segment elevation myocardial infarction: 31%, and median left ventricular ejection fraction [LVEF]: 50%). RESULTS: The prevalence of high MCV was 39 ± 6% (± 95% confidence interval) in the entire AMI population. High MCV was more prevalent in males, patients with low body mass index, non-diabetics and cigarette smokers (all p < 0.05). During the 180-day follow-up, there were 38 (15%) events, defined as another AMI or death. In a multivariable Cox proportional hazard model, female gender (p < 0.01), low LVEF (p < 0.001), previous AMI (p < 0.05), arterial hypertension (p < 0.05), and high MCV (p < 0.001) were prognosticators of pre-defined events. CONCLUSIONS: In non-anemic patients with AMI, high MCV is an independent prognostic factor of poor outcome defined as another AMI or death.

Stratifying risk for progression in IgA nephropathy: how to predict the future?

INTRODUCTION:  IgA nephropathy (IgAN) is characterized by a highly heterogeneous clinical course, which results in controversies regarding the assessment of individual prognosis and establishing the optimal treatment approach. OBJECTIVES:  The aim of the present study was to define risk factors for IgAN progression. We evaluated histopathological features derived from the Oxford classification of IgAN and additional, non­Oxford biopsy findings, as well as baseline and follow­up clinical data. PATIENTS AND METHODS:  We conducted a single­center retrospective study on 52 patients with biopsy­proven IgAN. The endpoint was an increase in serum creatinine levels of 50% from baseline. RESULTS:  Eight subjects (12%) reached the endpoint. Poor renal outcome was independently related to time­average proteinuria (TA­P) exceeding 2.0 g/d (P = 0.047), estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2 (P = 0.01), history of tonsillectomy (P = 0.01), and crescent lesions in renal biopsy (P = 0.03). High global sclerosis index (GSI) (P = 0.009), TA­P (P = 0.03), and the presence of microscopic hematuria (P = 0.03) were independent predictors of a more rapid rate of renal function loss, assessed by the velocity of eGFR decline. Of the variables included in the Oxford classification, only interstitial fibrosis and tubular atrophy proved to have prognostic value, as revealed by a univariate, but not multivariate Cox regression analysis. CONCLUSIONS:  The extent of proteinuria during follow­up and impaired renal function at the time of diagnosis remain the most significant clinical prognostic factors in IgAN. We also report additional, non­Oxford histopathological features that can be used for risk stratification in IgAN, including the GSI and the presence of crescents.