Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease.

AIM: The objective of this work was to define a value for the 99th percentile of high-sensitive troponin T and to evaluate the prognostic value of this biomarker in a population of patients with type 2 diabetes without a history of cardiovascular disease. METHODS: In this prospective, observational and analytic study, 482 patients with type 2 diabetes were enrolled. The patients were asymptomatic, with no history of cardiovascular events, renal insufficiency, or inflammatory or systemic disease. As events we considered a combined end point of major adverse cardiovascular events (MACE). RESULTS: 94.9% of the patients had detectable troponin values, 20.7% of the patients had troponin values above the healthy population reference upper threshold (14pg/mL). The 99th percentile value for this patient population was 48pg/mL. Age, sex, the glomerular filtration rate and hypertension were associated with troponin values>14pg/mL. The incidence of MACE was 3.96 per 100 patients/year (p/y) between those with hs-TnT>14pg/mL and 1.07 per 100 p/y between those with hs-TnT≤14pg/mL (HR=3.78 CI95 1.49-9.58; p=0.005). CONCLUSIONS: The 99th percentile value of troponin T in a population of patients with type 2 diabetes is 3-fold higher than the value proposed by the manufacturer for a healthy population. We also observed a significant difference in the distribution of troponin T values between men and women. This biomarker may be a valuable prognostic factor, since troponin T values above the reference upper threshold were associated with an increase in the risk of cardiovascular events in these patients.

Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease.

AIM: The objective of this work was to define a value for the 99th percentile of high-sensitive troponin T and to evaluate the prognostic value of this biomarker in a population of patients with type 2 diabetes without a history of cardiovascular disease. METHODS: In this prospective, observational and analytic study, 482 patients with type 2 diabetes were enrolled. The patients were asymptomatic, with no history of cardiovascular events, renal insufficiency, or inflammatory or systemic disease. As events we considered a combined end point of major adverse cardiovascular events (MACE). RESULTS: 94.9% of the patients had detectable troponin values, 20.7% of the patients had troponin values above the healthy population reference upper threshold (14pg/mL). The 99th percentile value for this patient population was 48pg/mL. Age, sex, the glomerular filtration rate and hypertension were associated with troponin values>14pg/mL. The incidence of MACE was 3.96 per 100 patients/year (p/y) between those with hs-TnT>14pg/mL and 1.07 per 100 p/y between those with hs-TnT≤14pg/mL (HR=3.78 CI95 1.49-9.58; p=0.005). CONCLUSIONS: The 99th percentile value of troponin T in a population of patients with type 2 diabetes is 3-fold higher than the value proposed by the manufacturer for a healthy population. We also observed a significant difference in the distribution of troponin T values between men and women. This biomarker may be a valuable prognostic factor, since troponin T values above the reference upper threshold were associated with an increase in the risk of cardiovascular events in these patients.

Kinetics of procalcitonin in infections caused by multidrug-resistant bacteria / Cinética de procalcitonina en infecciones causadas por bacterias multirresistentes

Resumen La cinética de la procalcitonina es útil para reducir la duración de la antibioticoterapia en pacientes críticos, pero no se analizó su rol en infecciones por gérmenes multirresistentes. Se realizó un estudio observacional retrospectivo, analizando las curvas de procalcitonina de pacientes con neumonías asociadas a ventilación mecánica (NAVM) y bacteriemias asociadas a catéter (BAC) con rescate bacteriano durante el período 1/11/16 a 1/7/19. Se estudiaron 16 pacientes con infección por gérmenes sensibles (10 BAC y 6 NAVM) y 10 por gérmenes multirresistentes (10 BAC y 10 NAVM). Los pacientes con BAC generadas por gérmenes multirresistentes presentaron valores de procalcitonina mayores que los pacientes con BAC por gérmenes sensibles: (39 ± 30 μg/l vs. 10.7 ± 11 μg/l, p = 0.02). Los pacientes con NAVM generada por gérmenes sensibles y multirresistentes presentaron valores de procalcitonina similares. El descenso de procalcitonina a niveles 80% menores al valor máximo o menores a 0.5 μg/l (con tratamiento antibiótico efectivo) fue más veloz en pacientes con infección por gérmenes sensibles (5 ± 1.8 días vs. 7.2 ± 2.9 días, p = 0.03). En las infecciones por gérmenes multirresistentes, la respuesta inflamatoria medida por procalcitonina fue más intensa y prolongada, aun con un tratamiento antibiótico efectivo. Sin embargo, el descenso se produjo antes de que finalizaran los esquemas antibióticos convencionales. Por este motivo, se considera necesario estudiar la potencial utilidad de protocolos antibióticos guiados por procalcitonina en pacientes con infecciones por gérmenes multirresistentes para reducir la exposición a antibióticos.

Abstract Procalcitonin guidance stimulates a reduction in the duration of antibiotic treatment in critically ill patients with a presumed bacterial infection, but its role in infections caused by multidrug-resistant bacteria has not been sufficiently explored. In this retrospective observational study, we analyzed procalcitonin curves of 32 patients with culture-confirmed ventilation-associated pneumonia (VAP) and catheter-related bloodstream infections (CRBSI) occurred during the period 11/1/2016 to 7/1/2019. Sixteen infections were caused by multidrug-resistant bacteria (10 CRBSI and 6 VAP) and other 16 by sensitive bacteria (10 CRBSI and 6 VAP). CRBSI generated by multidrug-resistant bacteria elicited significantly higher procalcitonin levels than CRBSI infections caused by sensitive bacteria (39 ± 30 μg/l vs. 10.7 ± 11 μg/l, p = 0.02). Patients with VAP caused by sensitive and multidrug-resistant bacteria elicited similar procalcitonin levels. The time to a decrease in procalcitonin level to less than 80% of the peak value or less than 0.5 μg/l upon effective antibiotic treatment was 7.2 ± 2.9 days in multidrug-resistant bacteria vs. 5 ± 1.8 days in sensitive bacteria (p = 0.03). In multidrug-resistant bacteria, the inflammatory response measured by procalcitonin is stronger and longer, even with an effective antibiotic treatment. However, the decline occurs before the conventional antibiotic scheme is completed. The potential application of antibiotic protocols guided by procalcitonin to these groups of patients grants further studies aimed to reduce exposure to antibiotics in critical multidrug-resistant infections.

[Kinetics of procalcitonin in infections caused by multidrug-resistant bacteria]. / Cinética de procalcitonina en infecciones causadas por bacterias multirresistentes.

Procalcitonin guidance stimulates a reduction in the duration of antibiotic treatment in critically ill patients with a presumed bacterial infection, but its role in infections caused by multidrug-resistant bacteria has not been sufficiently explored. In this retrospective observational study, we analyzed procalcitonin curves of 32 patients with culture-confirmed ventilation-associated pneumonia (VAP) and catheter-related bloodstream infections (CRBSI) occurred during the period 11/1/2016 to 7/1/2019. Sixteen infections were caused by multidrug-resistant bacteria (10 CRBSI and 6 VAP) and other 16 by sensitive bacteria (10 CRBSI and 6 VAP). CRBSI generated by multidrug-resistant bacteria elicited significantly higher procalcitonin levels than CRBSI infections caused by sensitive bacteria (39 ± 30 υg/l vs. 10.7 ± 11 υg/l, p = 0.02). Patients with VAP caused by sensitive and multidrug-resistant bacteria elicited similar procalcitonin levels. The time to a decrease in procalcitonin level to less than 80% of the peak value or less than 0.5 υg/l upon effective antibiotic treatment was 7.2 ± 2.9 days in multidrug-resistant bacteria vs. 5 ± 1.8 days in sensitive bacteria (p = 0.03). In multidrug-resistant bacteria, the inflammatory response measured by procalcitonin is stronger and longer, even with an effective antibiotic treatment. However, the decline occurs before the conventional antibiotic scheme is completed. The potential application of antibiotic protocols guided by procalcitonin to these groups of patients grants further studies aimed to reduce exposure to antibiotics in critical multidrug-resistant infections.

La cinética de la procalcitonina es útil para reducir la duración de la antibioticoterapia en pacientes críticos, pero no se analizó su rol en infecciones por gérmenes multirresistentes. Se realizó un estudio observacional retrospectivo, analizando las curvas de procalcitonina de pacientes con neumonías asociadas a ventilación mecánica (NAVM) y bacteriemias asociadas a catéter (BAC) con rescate bacteriano durante el período 1/11/16 a 1/7/19. Se estudiaron 16 pacientes con infección por gérmenes sensibles (10 BAC y 6 NAVM) y 10 por gérmenes multirresistentes (10 BAC y 10 NAVM). Los pacientes con BAC generadas por gérmenes multirresistentes presentaron valores de procalcitonina mayores que los pacientes con BAC por gérmenes sensibles: (39 ± 30 υg/l vs. 10.7 ± 11 υg/l, p = 0.02). Los pacientes con NAVM generada por gérmenes sensibles y multirresistentes presentaron valores de procalcitonina similares. El descenso de procalcitonina a niveles 80% menores al valor máximo o menores a 0.5 υg/l (con tratamiento antibiótico efectivo) fue más veloz en pacientes con infección por gérmenes sensibles (5 ± 1.8 días vs. 7.2 ± 2.9 días, p = 0.03). En las infecciones por gérmenes multirresistentes, la respuesta inflamatoria medida por procalcitonina fue más intensa y prolongada, aun con un tratamiento antibiótico efectivo. Sin embargo, el descenso se produjo antes de que finalizaran los esquemas antibióticos convencionales. Por este motivo, se considera necesario estudiar la potencial utilidad de protocolos antibióticos guiados por procalcitonina en pacientes con infecciones por gérmenes multirresistentes para reducir la exposición a antibióticos.