RESUMO
BACKGROUND: Prognostic factors of long-term survival can guide selection of patients for endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study was to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR) and the systemic immune-inflammation index (SIII) with survival after EVAR and to assess whether the addition of these biomarkers improved the prediction of survival after surgery. METHODS: Retrospective analysis of 284 consecutive patients who underwent an EVAR at a single institution. The association between biomarkers and survival was explored using generalized additive models with penalized smoothing splines and multivariate Cox models. C-statistics and continuous net reclassification indexes (c-NRI) were used to assess the improvement in prediction. RESULTS: Survival rates at 2 and 5 years were 83.9% and 66.2%, respectively. The predictive score of survival included hemoglobin (HR = 0.849, p = 0.004), statin intake (HR = 0.538, p = 0.004), atrial fibrillation (HR = 2.515, p < 0.001), heart failure (HR = 2.542, p = 0.017) and the non-revascularized coronary artery disease (HR = 2.163, p = 0.004). Spline analyses showed a linear relationship between survival and NLR, PLR, LMR and SII. After adjusting for the predictive score, there was an independent relationship between survival and NLR (HR = 1.072, p = 0.006), PLR (HR = 1.002, p = 0.014) and SII (HR = 1.000, p = 0.043). However, only the addition of NLR improved moderately the c-NRI. A NLR ≥ 3 was independently associated with lower survival rates at 2-years (HR 1.98; 95% CI 1.07-3.66) and 5-years (HR 1.84, 95% CI 1.22-2.78) of follow-up. CONCLUSIONS: Most inflammatory biomarkers are linear and independently associated with survival after EVAR, but only the NLR improved moderately the prediction of a survival score. Therefore, a NLR ≥ 3 may be used to identify patients with a low survival rate and help in decision-making.
Assuntos
Aneurisma da Aorta Abdominal , Procedimentos Endovasculares , Aneurisma da Aorta Abdominal/cirurgia , Biomarcadores , Humanos , Linfócitos , Masculino , Neutrófilos , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVES: The aim of this study was to characterize the physico-chemical properties of cocoa fibre (CF), to analyze its polyphenolic content and antioxidant capacity in vitro, and to investigate the effect of the administration of a polyphenolic extract of this cocoa fiber on the antioxidant capacity of the serum in rats. METHODS AND MATERIALS: Dietary fiber (DF) composition and polyphenolic (PP) content of the cocoa fiber were analyzed. The antioxidant capacity of the CF was determined by means of its reduction power (FRAP) and the capacity to scavenge free radicals (ABTS). To evaluate the bioavailability and the antioxidant capacity in vivo of the phenolic compounds of CF, an extract of these compounds was administred in the stomach of the rats with a gastric probe (100 mg PP/kg), taking blood samples at different time intervals. Sera were analyzed by HPLC to determine the presence/absence of PP or PP-metabolites. In orther to evaluate the antioxidant capacity of the serum FRAP and ABTS methods were used. RESULTS: Cocoa fiber was an excellent source of DF, with a high content of total dietary fiber (TDF), over 60% of the dry matter, made up mainly of insoluble dietary fiber (IDF; 83% of TDF). This fiber had just 1.15% of polyphenols, with low antioxidant activity. After intragastric administration of the PP-rich fraction a fast and measurable absorption of the CF polyphenols was observed, being epicatechin the main PP in blood. The absorption of this PP confers a significant, although transitory increase of the serum antioxidant capacity 10-45 minutes post-gavage; after this time, the antioxidant capacity progressively decreased reaching basal levels after 6 h. CONCLUSIONS: Cocoa fiber can be considered as an excellent source of DF, mainly insoluble dietary fiber; therefore, it could be used as an ingredient in fiber-rich functional foods. Besides the benefits derived from its high fiber content, the CF would provide protection against oxidative damage by means of its content in phenolic compounds (epicatechin) wich are absorbed maintaining the antioxidant properties in vivo.