Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial.

OBJECTIVE: Despite the use of spontaneous breathing trial (SBT), predicting weaning success remains a major clinical challenge. Because cardiovascular dysfunction could be a major underlying mechanism of weaning failure, we evaluated the role of the levels of B-type natriuretic peptide (BNP), a marker for cardiovascular function, in patients who passed a 2-hr SBT. DESIGN, SETTING, AND PATIENTS: Fifty-two patients recovering from acute respiratory failure were enrolled as the testing group to determine the predictive value of BNP. The predictive value of BNP was validated in a second independent cohort of 49 patients. Then, we combined both groups of patients to conduct the final analysis. MEASUREMENTS AND RESULTS: In the testing group of 52 patients, 41 passed SBT and were extubated. Of these patients, 33 patients (80%) were extubated successfully (extubation success) while eight patients (20%) were reintubated within 48 hrs (extubation failure). There were no differences in the baseline BNP levels, but the extubation failure group had significantly greater increases in BNP at the end of SBT than the extubation success groups (32.7%, 25-75 percentile = 25.7%-50.8% vs. 0.69%, -8.8%-10.72%, p < .001). The area under the receiver operating characteristic curves for the BNP change was 0.93 and an increase of BNP <20% during SBT had the best combination of sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for predicting extubation success (91%, 88%, 97%, 70%, and 91%). This threshold value of BNP change was then validated in an independent cohort. Combining BNP with SBT as extubation criteria increased the extubation success rate to 95% from 78% using SBT alone (p = .035). CONCLUSION: Measuring the percentage change in the BNP level during a SBT may help improve the predictive value of SBT on weaning outcome.

Illustrating the roles of C-reactive protein in the development of the metabolic syndrome in women--a cross-racial validation.

BACKGROUND AND AIMS: This study was designed to elucidate the role of C-reactive protein (CRP) as an inflammatory marker in the development of the metabolic syndrome (MS). METHODS AND RESULTS: A total of 333 women without current medication attended an obesity-screening programme held in Yun-Lin, Taiwan. Anthropometric measurements were obtained; biochemical profiles, lipid profiles and high-sensitivity CRP (hsCRP) were measured. A structural equation model (SEM) was constructed to demonstrate that obesity might initiate the sequential pathway that leads to a pro-inflammatory state and other metabolic derangements. The results of SEM in the Taiwanese women showed that obesity was positively associated with elevated CRP (B=0.69, p<0.001). The pro-inflammatory state could result in insulin resistance (B=0.57, p<0.001), which in turn could lead to dyslipidaemia (B=0.46, p<0.01). The association between obesity and hypertension was positive and direct (B=0.43, p<0.01) without the intermediation of inflammation or insulin resistance. The implications could be reproduced when the same model was applied to the metabolic profiles of the Caucasian participants in the National Health and Nutrition Examination Survey 1999-2002. CONCLUSION: Our study has demonstrated that obesity plays the central role in leading to hypertension and a pro-inflammatory state, insulin resistance and dyslipidaemia. The SEM has provided a comprehensive view to illustrate the complex interplay of the main components in the development of the MS, and this approach can be generalized to different populations.

The influence of estimated creatinine clearance on plasma homocysteine in hypertensive patients with normal serum creatinine.

OBJECTIVES: To examine the relation of estimated creatinine clearance (eCrCl) and plasma total homocysteine (tHcy) in hypertensive patients with a normal serum creatinine level. DESIGN AND METHODS: A total of 137 hypertensive patients (mean age 66.6 years, 69 men) with serum creatinine level 60 mL/min/1.73 m(2)). The CRI group was older (p<0.001), had higher tHcy (p<0.001), higher serum urea nitrogen (p<0.001), higher serum creatinine (p<0.001), lower eCrCl (p<0.001), and lower diastolic blood pressure (p=0.001). In univariate analysis, eCrCl had the strongest correlation with tHcy (r=-0.453, p<0.001). Significant correlations, ranging in decreasing order from r=-0.418, p<0.001 to r=-0.170, p=0.047, were also noted between tHcy and twelve other variables. In multivariate analysis, only eCrCl (p<0.001), usage of fibrate (p<0.001), serum level of vitamin B(12) (p=0.002), serum level of folic acid (p=0.009), and smoking (p=0.027) were independent predictors of tHcy. CONCLUSION: eCrCl is a strong independent predictor of tHcy in hypertensive patients with normal serum creatinine.

Serum C-reactive protein levels correlates better to metabolic syndrome defined by International Diabetes Federation than by NCEP ATP III in men.

The International Diabetes Federation (IDF) proposed a new definition for metabolic syndrome (MS) in 2005. We conducted this study to compare the association of MS by IDF and ATP III definition to various metabolic variables. In 2005, we enrolled 654 Chinese people in a screening program in Taiwan. Anthropometric and biochemical profiles, including high-sensitivity C-reactive protein (hsCRP), were measured. Serum hsCRP levels were higher in those with MS by IDF definition (2.4+/-1.9mg/l versus 1.3+/-1.4mg/l, p<0.0001). Serum hsCRP levels increase with the number of components of MS they met (p for trend<0.001). Serum LDL levels were higher in those with MS by IDF definition (131+/-39 versus 125+/-32, p<0.05) but not in those with MS by ATP III definition (p=0.2). Serum hsCRP levels correlate significantly to MS by ATP III definition, after adjusting for age, sex, smoking, body mass index, serum apolipoprotein A1 and LDL levels. Adding MS status by IDF definition in this model significantly increased model fitness in men (MS by IDF definition, partial r=0.18, p<0.05, MS by ATP III definition, partial r=0.12, p=0.071). In conclusion, IDF definition of MS has a stronger relationship with serum hsCRP than ATP III definition in men.

Decreased serum level of lipoprotein cholesterol is a poor prognostic factor for patients with severe community-acquired pneumonia that required intensive care unit admission.

PURPOSE: The purpose of this study is to investigate the prognostic values of the serum levels of lipids in patients with severe community-acquired pneumonia (CAP) that required intensive care unit (ICU) admission. MATERIALS AND METHODS: Patients who had severe CAP that required ICU admission were included. Serum lipid level was collected on the days 1 and 7 of ICU stay. Clinical outcome, including length of ICU stay, hospital stay, and death, were monitored prospectively. RESULTS: A total of 40 patients were enrolled in this study. Lower high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were found in nonsurvival group on ICU admission day 7 (survivors vs nonsurvivors; mean HDL, 41.8 vs 13.0 mg/dL, P = .002; LDL, 62.3 vs 30.3 mg/dL, P = 0.006, respectively). High-density lipoprotein cholesterol level of less than or equal to 17 mg/dL on day 7 (odds ratio, 1.23) and LDL cholesterol level of less than or equal to 21 mg/dL on day 7 (odds ratio, 1.10) could be a predictor of hospital mortality. The mean change in levels of HDL cholesterol in nonsurvivors decreased significantly than those in survivors from days 1 to 7 (8.5 vs -17.4 mg/dL, P = .04) but not LDL cholesterol. CONCLUSIONS: Decreased serum HDL cholesterol level from days 1 to 7 may be of prognostic value.

Association of amino-terminal pro-brain natriuretic peptide with metabolic syndrome.

OBJECTIVE: This study evaluated the relationship between individual components in metabolic syndrome (MetS) and amino-terminal pro-brain natriuretic peptide (NT-proBNP). METHODS: A screening program for MetS in 2008 in Taiwan excluded subjects aged <30 years and pregnant women. Fasting glucose, insulin level, high-sensitivity C-reactive protein (hsCRP), and NT-proBNP were assessed. A propensity-score matching process was used to select subjects with and without MetS comparable in age, gender, body height, and serum creatinine levels. A multiple regression model was used to determine the association between individual components of MetS and NT-proBNP. Finally 270 subjects with MetS and another 270 matched subjects without MetS aged ≥30 years were included. RESULTS: The subjects with MetS had higher uric acid and hsCRP, but not NT-proBNP. Multiple regression model showed that log (NT-proBNP) was positively associated with systolic blood pressure (ß=0.002 per mmHg, p=0.013), but negatively associated with body mass index (ß=-0.017 per kg/m(2), p=0.018), triglyceride (ß=-0.00048 per mg/dL, p=0.020) and insulin level (ß=-0.005 per mU/L, p=0.005). Log (NT-proBNP) was neutral to waist circumference, fasting glucose, high-density lipoprotein cholesterol, and diastolic blood pressure. CONCLUSION: MetS was not associated with serum NT-proBNP concentrations due to the contradictory effects of each component.

Seroprevalence of hepatitis A virus infection in persons with HIV infection in Taiwan: implications for hepatitis A vaccination.

OBJECTIVES: To retrospectively determine the prevalence of anti-hepatitis A virus (HAV) antibody in HIV-positive persons with different routes of HIV exposure and to describe its characteristics in order to guide vaccination policy. METHODS: The prevalence of anti-HAV antibody was compared between 1580 HIV-positive persons seeking medical attention and 2581 HIV-negative controls seeking health check-ups, who had undergone anti-HAV tests between 2004 and 2007. Comparisons were also made among groups of the HIV-positive patients who had acquired HIV via different routes of transmission. A multivariate logistic regression model was built to identify independent variables associated with anti-HAV seropositivity. RESULTS: The overall prevalence of anti-HAV antibody was 60.9% in the HIV-positive and 48.0% in the controls (p<0.001). The overall adjusted odds ratio (AOR) for positive anti-HAV antibody was 2.604 (95% confidence interval (CI) 2.106-3.219) in HIV-positive persons compared with HIV-negative persons. In addition, HIV-positive men who have sex with men (MSM), heterosexuals, and injecting drug users (IDU) all had significantly higher AOR for positive anti-HAV antibody than HIV-negative persons. In HIV-positive persons, older age (AOR 1.284, 95% CI 1.246-1.322) and IDU (AOR 5.137, 95% CI 3.499-7.542) were independently associated with an increased prevalence of anti-HAV antibody. Nearly 90% of the IDU had become seropositive for HAV after age 36-40 years, compared with heterosexuals and MSM after age 46-50 years, and controls after age 51-55 years. CONCLUSION: Our findings suggest that age groups to be targeted for HAV vaccination vary with the different routes of HIV exposure.

Cross-sectional validation of diabetes risk scores for predicting diabetes, metabolic syndrome, and chronic kidney disease in Taiwanese.

OBJECTIVE: To validate the performance of current diabetes risk scores (DRSs) based on simple clinical information in detecting type 2 diabetes, metabolic syndrome (MetSyn), and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS: The performance of 10 DRSs was evaluated in a cross-sectional population screening of 2,759 Taiwanese subjects. RESULTS: All DRSs significantly correlated with measures of insulin resistance, estimated glomerular filtration rate, and urine albumin excretion. The prevalence of screening-detected diabetes (SDM), MetSyn, and CKD increased with higher DRSs. For prediction of SDM, the Cambridge DRS by Griffin et al. and the Finnish DRS outperformed other DRSs in terms of discriminative power and model fit. For prediction of MetSyn and CKD, the Atherosclerosis Risk in Community Study score by Schmidt et al. outperformed other DRSs. CONCLUSIONS: Risk scores based on simple clinical information are useful to identify individuals at high risk for diabetes, MetSyn, and CKD in different ethnic populations.