Physical and psychological functioning of patients with chronic limb ischemia during a 1-year period after endovascular revascularization.

OBJECTIVE: Symptoms of peripheral artery disease (PAD) and patients' physical and psychological status are related in a vicious circle. The aim of this study was to determine the relationships between improvement in parameters of PAD after endovascular procedures and changes in patients' physical and psychological status. METHODS: We studied 140 consecutive patients with PAD: 50 patients with chronic limb-threatening ischemia (CLTI), 50 patients with intermittent claudication (IC) undergoing an endovascular procedure, and 40 patients with IC who were not qualified for leg revascularization. All participating patients were assessed at the beginning of the study and at 3 and 12 months of follow-up; scores taken included ankle-brachial index, 6-minute walking test distance, Barthel Index, activities of daily living index, instrumental activities of daily living (IADL) index, Mini-Mental State Examination, and Hospital Anxiety and Depression Scale. RESULTS: After 12 months of follow-up, an improvement in PAD-related symptoms following leg revascularization had been maintained in 56% of the patients with CLTI and in 68% of those with IC. Twelve months after endovascular leg revascularization, the scores in respect of activities of daily living, IADL, and Mini-Mental State Examination had increased, and scores for Hospital Anxiety and Depression Scale had decreased in patients with both CLTI and IC. A higher baseline score in the IADL index was associated with a reduction in the 1-year cardiovascular event risk (odds ratio, 95% confidence interval, 0.70; 0.54-0.91; P < .01). CONCLUSIONS: In patients with PAD, endovascular procedures not only improved PAD-related symptoms, but also ameliorated patients' physical state, improved cognitive function, and reduced depression.

Circulating Leptin, Adiponectin, and Tumor Necrosis Factor-Alpha in Patients Undergoing Surgery Due to Colorectal Cancer.

BACKGROUND: Adipocytokines have been proposed as factors mediating associations between obesity and inflammation in patients with colorectal cancer (CRC). Thus, the aim of this study was to determine the clinical relationships between blood concentrations of leptin (LEP), adiponectin (ADP), and tumor necrosis factor alpha (TNF-alpha) and the outcomes measured in patients with CRC undergoing surgery. PATIENTS AND METHODS: History, body composition, and blood concentrations of LEP, ADP, and TNF-alpha were determined in 107 patients undergoing surgery due to CRC. The patients were followed up for 619.72 ± 371.65 days. RESULTS: Compared to patients with stage II CRC, individuals with clinical stage I CRC had significantly lower ADP and higher TNF-alpha blood concentrations. We found significant correlations between the clinical stage of CRC (early vs. localized vs. metastatic) and the following: crude blood ADP concentration (R = 0.25; p = 0.015), ADP-to-TNF-alpha ratio (R = 0.31; p = 0.002), and ADP when indexed to body surface area (R = 0.25; p = 0.008) and to fat mass (R = 0.25; p = 0.016). The risk of death during the long-term follow-up period was independently related to the clinical stage of CRC, impairment of the patient's functional status, and higher blood carcinoembryonic antigen concentration. In Kaplan-Meier survival analysis, patients with blood LEP concentrations adjusted to a visceral adipose tissue score of ≥0.47 had a significantly better likelihood of surviving than their counterparts. CONCLUSIONS: In patients with CRC undergoing surgery, blood ADP and TNF-alpha concentrations were associated with the clinical stage of the cancer, likelihood of radical tumor excision, occurrence of nonsurgical postoperative complications, and long-term survival, which suggests the role of dysregulation in the endocrine function of adipose tissue in response to the neoplasmatic process.

Blood adipocytokine concentration in patients with peripheral artery disease.

BACKGROUND: Inflammatory responses mediated by adipocytokines may affect both atherosclerosis development and progression, as well as the risk of in-stent restenosis. The aim of this study was to determine the relationships between blood leptin, adiponectin and tumor necrosis factor-α (TNF-α) concentrations and the 1-year outcome of superficial femoral artery (SFA) stenting. METHODS: Blood concentrations of leptin, adiponectin and TNF-α were determined in 70 patients undergoing SFA stenting due to intermittent claudication and in 40 patients undergoing carotid artery stenting (CAS). All subjects were followed up for at least 1 year in relation to the occurrence of clinically driven target lesion revascularization (TLR) or a major adverse cardiovascular event (MACE). RESULTS: Patients undergoing SFA stenting and CAS had similar blood adipocytokine concentrations. Patients with diabetes mellitus presented a higher leptin concentration, lower adiponectin-to-leptin ratio, and lower blood adiponectin concentration indexed to fat mass (FM) and to visceral adiposity score (VAS). In Kaplan-Meier analysis, blood concentration of TNF-α indexed to FM and to VAS was higher in patients who underwent TLR and MACE. However, in multifactorial analysis, the severity of atherosclerosis lesions in the femoropopliteal vascular region, estimated in relation to TASC-II classification, was the only predictor of TLR. CONCLUSIONS: Circulating adipocytokines did not distinguish patients with different clinical manifestations of atherosclerosis. Higher ratios of TNF-α -to-FM and to VAS before SFA stenting were related to TLR and MACE occurrence. Dysregulation in adipocytokine secretion may be a potential mediator of a proatherogenic action of diabetes mellitus in patients with peripheral artery disease.

Total blood lymphocyte count as a prognostic factor among unselected inpatients.

PURPOSE: The aim of this study was to determine the relationships between total lymphocyte count (TLC) and prognosis among inpatients. PATIENTS AND METHODS: We retrospectively analyzed data from electronic medical documentation of 54 976 inpatients hospitalized in an urban university hospital during 3 consecutive years (2014-2017). RESULTS: TLC was available for 12 651 (23.01%) of the inpatients. Patients with TLC <0.8 G/L constituted about 15% of the inpatients studied and had the highest risk of death, hospital readmission within 14 days, hospital readmission within 30 days and hospital readmission within 1 year, the lowest values for biochemical parameters of nutritional status assessment, and the highest C-reactive protein levels. An increase in TLC was associated with reduced risk of in-hospital death (odds ratio [OR]; 95% confidence interval [CI]): 0.31; 0.27-0.36 and 14-day readmission: 0.78; 0.72-0.86. The risk of in-hospital death associated with the Nutritional Risk Screening 2002 (NRS-2002) score, blood albumin concentration, and the score for the combined values of hemoglobin, TLC, albumin and neutrophils (HLAN) was (OR; 95% CI): 2.44; 2.35-2.53; 0.32; 0.28-0.36; and 0.96; 0.94-0.97; respectively. CONCLUSIONS: TLC < 0.8 G/L is associated with the highest risk of in-hospital death, 14-day and 30-day readmission, and longer in-hospital stay. An increase in TLC predicted in-hospital survival and freedom from early readmission with a power similar to or greater than a number of prognostic formulas based on questionnaires (e.g. NRS-2002), biochemical parameters (e.g. albumin) and formulas composed of multiple parameters (e.g. HLAN).

Leptin, adiponectin, tumor necrosis factor α, and irisin concentrations as factors linking obesity with the risk of atrial fibrillation among inpatients with cardiovascular diseases.

BACKGROUND: The endocrine function of adipose tissue and skeletal muscles mediates the risk of cardiovascular complications of obesity. AIMS: The aim of this study was to determine the associations of leptin, adiponectin (ADA), tumor necrosis factor α (TNF­α), and irisin levels with the diagnosis of atrial fibrillation (AF) on admission to the hospital as well as parameters of transthoracic echocardiography among inpatients with cardiovascular diseases (CVDs). METHODS: The study included 80 consecutive patients hospitalized due to paroxysmal or persistent AF and a control group of 165 age- and sex­matched individuals admitted due to exacerbation of chronic CVD. In all participants, we assessed serum leptin, ADA, TNF­α, and irisin concentrations, body composition determined by bioelectrical impedance analysis, and transthoracic echocardiographic parameters. RESULTS: Compared with controls, patients with AF had greater fat mass (FM), higher serum leptin levels and lower levels of ADA, TNF­α, and irisin when indexed to body surface area, FM, and visceral adiposity. Hyperleptinemia slightly increased the risk of AF (odds ratio [OR], 1.02; 95% CI, 1.01-1.03; P <0.01). The correlation was stronger after indexation to FM (OR, 1.34; 95% CI, 1.01-1.81; P <0.05). The coefficients of significant correlations with echocardiographic parameters were stronger for irisin than for adipocytokines: 0.16 to 0.35 and 0.12 to 0.22, respectively. CONCLUSIONS: Adipocytokines and irisin exert a significant but weak effect on heart chamber size and affect the risk of AF occurrence. Their blood concentrations do not seem to be related simply to body composition but probably depend on individual variations in adipocytokine and myokine secretion as a result of numerous factors.