RESUMO
BACKGROUND: Vasopressin and adrenomedullin and their stable by-products copeptin and midregional part of proadrenomedullin (MR-proADM) are promising biomarkers for the development of preeclampsia. However, clinical use is hampered by the lack of trimester-specific reference intervals. We therefore estimated reference intervals for copeptin and MR-proADM in disease-free Dutch women throughout pregnancy. METHODS: Apparently healthy low risk pregnant women were recruited. Exclusion criteria included current or past history of endocrine disease, multiple pregnancy, use of medication known to influence thyroid function and current pregnancy as a result of hormonal stimulation. Women who miscarried, developed hyperemesis gravidarum, hypertension, pre-eclampsia, hemolysis elevated liver enzymes and low platelets, diabetes or other disease, delivered prematurely or had a small for gestational age neonate were excluded from analyses. Blood samples were collected at 9-13 weeks (n=98), 27-29 weeks (n=94) and 36-39 weeks (n=91) of gestation and at 4-13 weeks post-partum (PP) (n=89). Sixty-two women had complete data during pregnancy and PP. All analyses were performed on a Kryptor compact plus. RESULTS: Copeptin increases during pregnancy, but 97.5th percentiles remain below the non-pregnant upper reference limit (URL) provided by the manufacturer. MR-proADM concentrations increase as well during pregnancy. In trimesters 2 and 3 the 97.5th percentiles are over three times the non-pregnant URL provided by the manufacturer. CONCLUSIONS: Trimester- and assay-specific reference intervals for copeptin and MR-proADM should be used. In addition, consecutive measurements and the time frame between measurements should be considered as the differences seen with or in advance of preeclampsia can be expected to be relatively small compared to the reference intervals.
Assuntos
Adrenomedulina/sangue , Glicopeptídeos/sangue , Gravidez/sangue , Precursores de Proteínas/sangue , Ensaio de Imunoadsorção Enzimática/normas , Feminino , Humanos , Estudos Longitudinais , Valores de ReferênciaRESUMO
BACKGROUND: Procalcitonin (PCT) is a relatively new, promising indirect parameter for infection. In the intensive care unit (ICU) it can be used as a marker for sepsis. However, in the ICU there is a need for reliable markers for clinical deterioration in the critically ill patients. This study determines the clinical value of PCT concentrations in recognizing surgical complications in a heterogeneous group of general surgical patients in the ICU. MATERIAL AND METHODS: We prospectively collected PCT concentration data from April 2010 to June 2012 for all general surgical patients admitted to the ICU. Both the relationships between PCT levels and events (diagnostic and therapeutic interventions) as well as between PCT levels and surgical complications (abscesses, bleeding, perforation, ischemia, and ileus) were studied. RESULTS: PCT concentrations were lower in patients who developed complications than those who did not develop complications on the same day, although not significant (P = 0.27). A 10% increase in PCT levels resulted in a 2% higher complication odds, but again this was not significant (odds ratio [OR], 1.020; 95% confidence interval [CI], 0.961-1.083; P = 0.51). Even a 20% or 30% increase in PCT concentrations did not result in higher complication probability (OR, 1.039; 95% CI, 0.927-1.165 and OR, 1.057; 95% CI, 0.897-1.246). Furthermore, an increase in PCT levels did not show an increase or a reduction in the number of diagnostic and therapeutic interventions. CONCLUSIONS: An increase in PCT levels does not help to predict surgical complications in critically ill surgical patients.
Assuntos
Calcitonina/sangue , Precursores de Proteínas/sangue , Sepse/metabolismo , Infecção da Ferida Cirúrgica/metabolismo , Abscesso/diagnóstico , Abscesso/metabolismo , Abscesso/mortalidade , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Peptídeo Relacionado com Gene de Calcitonina , Estado Terminal , Feminino , Mortalidade Hospitalar , Humanos , Íleus/diagnóstico , Íleus/metabolismo , Íleus/mortalidade , Unidades de Terapia Intensiva , Isquemia/diagnóstico , Isquemia/metabolismo , Isquemia/mortalidade , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/metabolismo , Hemorragia Pós-Operatória/mortalidade , Prognóstico , Estudos Prospectivos , Sepse/diagnóstico , Sepse/mortalidade , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/mortalidadeAssuntos
Hemocromatose/genética , Antígenos de Histocompatibilidade Classe I/genética , Proteínas de Membrana/genética , Mutação de Sentido Incorreto , Mutação Puntual , Adolescente , Substituição de Aminoácidos , Feminino , Proteína da Hemocromatose , Heterozigoto , Antígenos de Histocompatibilidade Classe I/química , Temperatura Alta , Humanos , Masculino , Proteínas de Membrana/química , Pessoa de Meia-Idade , Desnaturação de Ácido Nucleico , Hibridização de Ácido Nucleico , Dobramento de Proteína , Análise de Sequência de DNA , Relação Estrutura-AtividadeRESUMO
BACKGROUND: Genotyping of HLA-DQ2.2, HLA-DQ2.5, and HLA-DQ8 is important in celiac disease (CD). The absence of these three genotypes has a strong negative predictive value. METHODS: We designed multiplex ligation-dependent probe amplification (MLPA) for the combined detection of HLA-DQ2.2, HLA-DQ2.5, and HLA-DQ8. The MLPA probe mix was validated against a set of 59 samples characterized by conventional techniques. RESULTS: The MLPA assay genotyped all 59 samples correctly when compared to the results obtained by PCR-SSCP/HD or PCR-SSO and PCR-SSP. CONCLUSION: The MLPA assay provides a reliable single-reaction analysis of the CD risk genotypes HLA-DQ2.2, HLA-DQ2.5, and HLA-DQ8 allowing for stratification or exclusion of disease risk.