ABSTRACT
AIMS: Glucagon-like peptide 1 (GLP-1) is a gut incretin hormone inducing post-prandial insulin secretion. Glucagon-like peptide 1 levels were recently found to be increased in patients with acute myocardial infarction. Glucagon-like peptide 1 receptor agonists improve cardiovascular outcomes in patients with diabetes. The aim of this study was to assess the predictive capacity of GLP-1 serum levels for cardiovascular outcome in patients with myocardial infarction. METHODS AND RESULTS: In 918 patients presenting with myocardial infarction [321 ST-segment elevation myocardial infarction and 597 non-ST-segment elevation myocardial infarction (NSTEMI)] total GLP-1, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the Global Registry of Acute Coronary Events (GRACE) score were assessed at time of hospital admission. The primary composite outcome of the study was the first occurrence of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Kaplan-Meier survival plots and univariable Cox regression analyses found GLP-1 to be associated with adverse outcome [hazard ratio (HR) of logarithmized GLP-1 values: 6.29, 95% confidence interval (CI): 2.67-14.81; P < 0.0001]. After further adjustment for age, sex, family history of cardiovascular disease, smoking, diabetes, hypertension, hypercholesterinaemia, glomerular filtration rate (GFR) CKD-EPI, hs-CRP, hs-Troponin T, and NT-proBNP levels the HR remained significant at 10.98 (95% CI: 2.63-45.90; P = 0.0010). Time-dependent receiver operating characteristic curve analyses illustrated that GLP-1 levels are a strong indicator for early events. For events up to 30 days after admission, GLP-1 proved to be superior to other biomarkers including hs-Troponin T, GFR CKD-EPI, hs-CRP, and NT-proBNP. Adjustment of the GRACE risk estimate by addition of GLP-1 increased the area under the receiver operating characteristic curve over time in NSTEMI patients. CONCLUSION: In patients hospitalized for myocardial infarction, GLP-1 levels are associated with cardiovascular events.
Subject(s)
Cardiovascular Diseases , Myocardial Infarction , Biomarkers , Cardiovascular Diseases/etiology , Glucagon-Like Peptide 1 , Heart Disease Risk Factors , Humans , Natriuretic Peptide, Brain , Peptide Fragments , Prognosis , Risk FactorsABSTRACT
Background: Acute kidney injury (AKI) as complication after open and endovascular repair of thoracoabdominal aortic aneurysm (TAAA) is one major predictor of mortality and postoperative complications. We evaluated tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) as combined early biomarker for AKI detection and predictor of patients' outcome. Patients and methods: Between 2014 and 2015, 52 patients have been enrolled in this observational study, of whom 29 (55.8%) underwent elective open repair and 23 (44.2%) endovascular repair. TIMP2 × IGFBP7 were measured until 48 hours after admission on intensive-care unit (ICU) and were analyzed regarding their predictive ability for AKI (defined according to the KDIGO criteria) requiring temporary renal replacement therapy (RRT) and 90-day mortality using ROC curves. Results: Mean patient age was 64.5 years (Min: 43, Max: 85), endovascular treated patients were older (p <0.0001). 40.4% (n = 21) developed AKI, and 21.2% (n = 11) required renal replacement therapy. In-hospital and total mortality rates were 7.7% (n = 4) and 9.6% (n = 5), respectively. At no time a significant difference in TIMP2 × IGFB7 levels between patients undergoing open or endovascular surgery was observed. The predictive quality of the TIMP2 × IGFBP7 value on ICU admission was sound regarding AKI requiring temporary renal replacement therapy (sensitivity: 55.56% [38.1-72.1%], specificity: 90.91% [58.7-99.8%] with an area under the curve [AUC]: 0.694 [0.543-0.820]). Mean follow-up was 13.2 months (Min: 2, Max: 20), regarding the 90-day mortality, the predictive property of the TIMP2 × IGFBP7 value was not sufficient (sensitivity: 80% [28.4-99.5%], specificity: 52.38% [36.4-68%], and AUC: 0.607 [0.454-0.746]). Conclusions: TIMP2 × IGFBP7 level measured 6-12 hrs postoperatively may be useful as an early detectable biomarker for AKI requiring temporary renal replacement therapy. It seems not suited to predict patients' outcome following complex thoracoabdominal aortic surgery, regardless if performed by open or endovascular repair.
Subject(s)
Acute Kidney Injury , Aortic Aneurysm, Abdominal , Aortic Aneurysm, Thoracic , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Biomarkers , Humans , Middle Aged , Renal Replacement Therapy , Tissue Inhibitor of Metalloproteinase-2ABSTRACT
BACKGROUND: Despite all efforts, spinal cord ischemia (SCI) is a relevant and feared complication after open and endovascular thoracoabdominal aortic aneurysm (TAAA) repair. Besides the established correlation of motor evoked potentials (MEPs) and SCI, the usage of biomarkers for early detection of SCI intraoperatively and postoperatively after TAAA surgery is scarcely described in literature. METHODS: The methods include retrospective assessment of 33 patients (48.48% male) undergoing open and endovascular TAAA repair between January 2017 and January 2018. Levels of the biomarkers neurone-specific enolase (NSE), glial fibrillary acidic protein (GFAP), and S100 B were correlated with a decrease of the amplitude of the MEPs of more than 50%, indicating SCI. Linear mixed models were applied to test for differences in the biomarker levels between open and endovascular surgery and between different times of measurement. Post hoc analyses were performed using Tukey's multiple comparisons test. Logistic regression models were used to investigate the association between GFAP, NSE, and S100 B levels at different times and a significant decrease in MEP or in-hospital mortality. RESULTS: Altogether, 19 patients were treated by endovascular repair; 14 patients were treated by open repair; 5 patients were treated because of a type I TAAA; 7 received treatment because of a type II TAAA; 7, 10, and 4 patients received type III, IV, or V TAAA repair, respectively. In-hospital mortality was 18.18% (n = 6); 5 of these patients were treated because of symptomatic TAAA. MEP decrease could be observed in 18 cases (54.5%), with 16 (48.4%) recovering during the intervention. SCI could be observed in 9.09% (n = 3), 2 endovascular repairs leading to paraplegia and one open repair leading to paraparesis. All biomarkers showed increasing levels over time, with no statistically significant difference between open and endovascular repair. The difference in NSE and S100 B levels between the different times of measurements was statistically significant (P < 0.0001, P = 0.0017, respectively). In a univariable logistic regression analysis, no correlation with the end points "significant decrease in MEP" or "in-hospital mortality" was observed for any of the assessed biomarkers. CONCLUSIONS: SCI-related biomarkers, namely NSE and S100 B, show a relevant increase directly after open and endovascular TAAA surgery, while no clear association between these biomarker levels and an intraoperatively measurable indicator for SCI could be observed.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Glial Fibrillary Acidic Protein/blood , Phosphopyruvate Hydratase/blood , S100 Calcium Binding Protein beta Subunit/blood , Spinal Cord Ischemia/blood , Adult , Aged , Aged, 80 and over , Aortic Aneurysm, Thoracic/blood , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Biomarkers/blood , Blood Vessel Prosthesis Implantation/mortality , Endovascular Procedures/mortality , Evoked Potentials, Motor , Female , Hospital Mortality , Humans , Intraoperative Neurophysiological Monitoring , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Risk Factors , Spinal Cord Ischemia/diagnosis , Spinal Cord Ischemia/etiology , Spinal Cord Ischemia/mortality , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: This study compared the outcomes of open one stage with open two stage repair of type II thoraco-abdominal aortic aneurysms (TAAA). METHODS: This retrospective study included 94 patients (68 men) with a mean ± SD age of 54.5 ± 14 years who underwent open type II TAAA repair from March 2006 to January 2016. The mean aneurysm diameter was 65 ± 14.4 mm. The median follow up was 42 months (range 12-96). Seventy-six patients received one stage open repair and 18 patients were treated in two steps: 12 received two open procedures (thoracic and abdominal) and six received hybrid repair (one open and one endovascular procedure). This study focused on the comparison of open one stage and open two stage TAAA repair. The median time between the two steps was 31.5 days (range 1-169). RESULTS: In hospital mortality after open one stage repair versus open two stage type II repair was 22.4% versus 0% (odds ratio 7.352, 95% confidence interval [CI] 0.884-959.1]; p = .19). The one year survival rate after one stage repair versus open two stage repair was 74.7% (95% CI 62.7-83.3) versus 90.9% (95% CI 50.8-98.7 [p = .225]). The five year survival rate after one stage repair versus open two stage repair was 53.0% (95% CI 37.2-66.5) versus 90.9% (95% CI 50.8-98.7 [p = .141]). The hazard ratio for survival after one stage repair and after open two stage repair was 4.563 (95% CI 96.9-81.4 [p = .137]). Paraplegia was observed after open one stage repair versus open two stage in 10.5% vs. 8% (p = 1). Acute kidney injury requiring permanent dialysis and myocardial infarction were assessed for after open one stage repair and open two stage and were seen in 3.9% vs. 0% (p = 1) and in 5.3% vs. 0% (p = 1), respectively. CONCLUSION: Open two stage repair may be recommended as a treatment option for type II TAAAs if anatomically feasible, as it has a lower mortality and similar complication rates to one stage repair.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Adult , Aortic Aneurysm, Abdominal/mortality , Blood Vessel Prosthesis Implantation/mortality , Endovascular Procedures/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Operative Time , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
Acute kidney injury (AKI) is a relevant complication following thoracoabdominal aortic aneurysm repair (TAAA). Biomarkers, such as secretory leucocyte peptidase inhibitor (SLPI), may enable a more accurate diagnosis. In this study, we tested if SLPI measured in serum is an appropriate biomarker of AKI after TAAA repair. In a prospective observational single-center study including 33 patients (51.5% women, mean age 63.0 ± 16.2 years) undergoing open and endovascular aortic aneurysm repair in 2017, SLPI was measured peri-operatively (until 72 h after surgery). After surgery, the postoperative complications AKI, as defined according to the KDIGO diagnostic criteria, sepsis, death, MACE (major cardiovascular events) and, pneumonia were assessed. In a subgroup analysis, patients with preexisting kidney disease were excluded. Of 33 patients, 51.5% (n = 17) of patients developed AKI. Twelve hours after admission to the intensive care unit (ICU), SLPI serum levels were significantly increased in patients who developed AKI. Multivariable logistic regression revealed a significant association between SLPI 12 hours after admission to ICU and AKI (P = 0.0181, OR = 1.055, 95% CI = 1.009-1.103). The sensitivity of SLPI for AKI prediction was 76.47% (95% CI = 50.1-93.2) and the specificity was 87.5% (95% CI = 61.7-98.4) with an AUC = 0.838 (95% CI = 0.7-0.976) for an optimal cut-off 70.03 ng/ml 12 hours after surgery. In patients without pre-existing impaired renal function, an improved diagnostic quality of SLPI for AKI was observed (Sensitivities of 45.45-91.67%, Specificities of 77.7-100%, AUC = 0.716-0.932). There was no association between perioperative SLPI and the incidence of sepsis, death, MACE (major cardiovascular events), pneumonia. This study suggests that SLPI might be a post-operative biomarker of AKI after TAAA repair, with a superior diagnostic accuracy for patients without preexisting impaired renal function.
Subject(s)
Acute Kidney Injury/diagnosis , Aortic Aneurysm, Thoracic/pathology , Biomarkers/blood , Secretory Leukocyte Peptidase Inhibitor/blood , Acute Kidney Injury/etiology , Aged , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/therapy , Area Under Curve , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Endovascular Procedures/adverse effects , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Postoperative Complications , Prospective Studies , ROC Curve , Sensitivity and Specificity , Sepsis/epidemiology , Sepsis/etiologyABSTRACT
BACKGROUND: OAGB-MGB emerged as a standard procedure, albeit RYGB remains the most frequently performed gastric bypass. Comparative studies are scarce. METHODS: Prospectively collected data (July 2006 to November 2017) from a large sample size and adequate follow-up were analyzed using logistic regression and linear mixed models. Total weight loss (TWL) within the first 3 years was defined as primary outcome and duration of operation, perioperative, and late complications and comorbidity remission as secondary outcomes. RESULTS: Three hundred twenty-four OAGB-MGBs (age 42.51 ± 11.36 years, 74.69% females) presented with higher preoperative BMI (53.75 ± 6.51 kg/m2 vs. 44.53 ± 3.65 kg/m2, p < 0.0001) and higher comorbidity prevalence than 288 RYGBs (age 41.4 ± 10.04 years, 79.86% females). Duration of operation was 80.28 ± 20.31 min in OAGB-MGB and 103.36 ± 29.69 min in RYGB (p < 0.0001). Intraoperative complications (4.63% resp. 8.68%), early re-laparoscopy (0.62% resp. 0.69%), leakage (1.23% resp. 1.74%), internal hernias (IH) (0.32% resp. 3.85%), marginal ulcers (3.23% resp. 5.59%), gastroesophageal reflux (3.55% resp. 0.70%), and insufficient weight loss at 3 years (4.19% resp. 5.59 %) were comparable in OAGB-MGB resp. RYGB. Follow-up rates at 1 and 3 years declined from 76.71 to 42.86% (OAGB-MGB) resp. 79.15 to 50.00% (RYGB). TWL (OAGB-MGB, 36.18 ± 9.18%; RYGB, 33.8 ± 8.75%), malnutrition (OAGB-MGB, 4.19%; RYGB, 2.45%), and comorbidity remission 3 years postoperatively revealed comparable robust data. Anastomotic stenosis (1.94% resp. 14.69%) and dumping syndrome (3.55% resp. 6.64%) were less frequent in OAGB-MGB. CONCLUSIONS: TWL, malnutrition, and comorbidity remission 3 years postoperatively were comparable. Gastroesophageal reflux was less frequent after RYGB (p = 0.0729), whereas shorter operation times (p < 0.0001), less frequent stenosis (p < 0.0001), and dumping syndrome (p = 0.0018) were found in OAGB-MGB. Further RCTs are required.