Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts.

BACKGROUND: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C2HEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes. MATERIAL AND METHODS: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients' baseline characteristics were retrieved to calculate the C2HEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home/sudden-deterioration/rehabilitation) and adverse in-hospital clinical events. RESULTS: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk C2HEST stratum. The C2HEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group-levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that C2HEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury. CONCLUSIONS: We demonstrated the usefulness and performance of the C2HEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects.

The frequency of TLR2 (rs3804099, rs3804100, and rs5743708) and TLR4 (rs4986790 and rs4986791) polymorphisms in women with polycystic ovary syndrome - preliminary study.

INTRODUCTION: Low-grade chronic inflammation may participate in PCOS etiology. Toll-like receptors (TLRs) may play a pivotal role in the initiation and progression of inflammatory process. We examined TLR2 and TLR4 gene polymorphisms in women with PCOS and their associations with metabolic/hormonal parameters. MATERIAL AND METHODS: Sixty-eight women qualified for the study. PCOS was diagnosed in 40 women. The control group consisted of 28 women. All patients underwent anamnesis, physical examination, anthropometric measurements, and biochemical/hormonal assessments. The TLRs gene polymorphism was tested using PCR and the minisequencing method. RESULTS: The frequency of TLR2 gene polymorphisms genotypes (rs3804099, rs3804100, and rs5743708) did not differ significantly between the groups. The difference in frequency of genotypes of TLR4 gene polymorphisms (rs4986790 and rs4986791) was close to the statistical significance level. No significant correlations between TLR2/TLR4 polymorphisms and anthropometric/metabolic parameters in PCOS group were observed. However, the relationship between HDL concentration and TLR2 S450S (rs3804100) polymorphism was close to the statistical significance level. Positive correlations between the two TLR4 polymorphisms (rs4986790 and rs4986791) were found, as well as between the TLR2 S450S (rs3804100) gene polymorphism and FSH concentration. CONCLUSIONS: The TLR4 gene polymorphism may play a role in the PCOS etiopathogenesis but this observation needs further investigation.

Metastasis of adrenocortical carcinoma to the heart.

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Etiology, baseline clinical profile and comorbidities of patients with Cushing's syndrome at a single endocrinological center.

PURPOSE: The aim of this study was to compare phenotype of patients with pituitary, adrenal and ectopic CS and identify the differences regarding biochemical parameters, clinical presentations, and comorbidities in CS patients who were diagnosed at the single endocrinological center in Wroclaw. METHODS: The study population involved 64 patients with CS (53 women and 11 men) diagnosed in Department of Endocrinology, Diabetes and Isotope Therapy in 2000-2018. Patients were divided into three etiologic groups: pituitary dependent-CS (P-CS) (64%), adrenal dependent CS (A-CS) (25%), and CS from an ectopic source (E-CS) (11%). RESULTS: Percentage of men in the A-CS group was significantly higher than in the other etiologic groups. ACTH, UFC, and cortisol in DST were significantly higher in E-CS group compare to P-CS and A-CS (p < 0.05). Mean potassium level in E-CS group was significantly lower than in P-CS and A-CS (p < 0.05). Median of time elapsed to diagnosis was significantly lower in the E-CS group compared with either the P-CS and the A-CS group (p < 0.01). The most frequently symptoms in CS patients were skin alterations (82.8%), weight gain (81.2%), and hypertension (81.2%). CONCLUSIONS: The epidemiology of CS is changing toward a growing proportion of A-CS. All patients with E-CS presented a profound hypokalemia. Salient hypokalemia could be a biochemical marker more suggestive for E-CS rather than P-CS. The incidence of diabetes is more frequent in E-CS group than in P-CS and A-CS groups.

Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing's Syndrome.

Introduction: The impairment in bone microarchitecture and reduced bone quality are relevant mechanisms underlying the increased fracture risk in Cushing's syndrome (CS). The trabecular bone score (TBS) is a relatively novel textural index of bone microarchitecture. Purpose: The objective of the study was to compare TBS, bone mineral density (BMD), and fracture risk in patients with endogenous CS to controls. We have investigated the association of TBS with anthropometric parameters and 25(OH) vitamin D concentrations. Materials and Methods: The study group comprised 19 consecutive patients with CS (14 women and 5 men; mean age 45.84 ± 13.15 years) and sex-, age-matched 36 controls (25 women and men; mean age 52.47 ± 8.98 years). Anthropometric parameters, biochemical and hormonal data were compared between groups. Lumbar spine (L1-L4) and femoral neck BMD (LS BMD, FN BMD) measurements were performed. TBS values were obtained from lumbar spine DXA images. Results: TBS was significantly lower in patients with CS compared to controls (p = 0.0002). The 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture were significantly higher in the CS group than in controls (p = 0.03, p < 0.0001, respectively). All subjects from the CS group with fractures had low TBS value (degraded microarchitecture). TBS correlated negatively with the duration of disease in patients with CS (r = -0.590 p = 0.008). Conclusions: The patients with active CS have altered bone microstructure as indicated by the decreased TBS and are at higher risk of hip and a major osteoporotic fractures. TBS seems to be a very important analytical tool facilitating fracture risk assessment in endogenous hypercortisolism.

Adropin in women with polycystic ovary syndrome.

INTRODUCTION: Women with polycystic ovary syndrome (PCOS) frequently develop metabolic complications. Among the newly found factors responsible for metabolic disorders, adropin seems to be of a great significance. MATERIAL AND METHODS: In total 134 women aged 17-45 years were enrolled. The PCOS group consisted of 73 women, diagnosed on the basis of Executive Committee of the European Society of Human Reproduction and Embryology - American Society for Reproductive Medicine (ESHRE-ASRM) criteria. All PCOS women presented phenotype A of PCOS. The control group consisted of 61 women with regular menstrual cycles, matched for nutritional status. All women underwent anamnesis, physical examination, anthropometric measurements, abdominal and transvaginal ultrasound, and dual-energy X-ray absorptiometry (DXA). Serum adropin levels were determined by ELISA. Biochemical [fasting glucose and insulin, oral glucose tolerance test, lipid and sex hormone-binding globulin (SHBG)] and hormonal (testosterone, androstenedione, luteinizing hormone, follicle-stimulating hormone and oestradiol) measurements were performed. Insulin resistance indices [(Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI), Matsuda] and free androgen index (FAI) were calculated according to the standard formula. RESULTS: Serum adropin levels were lower in the PCOS group (0.475 ± 0.200 vs. 0.541 ± 0.220, p = 0.069), but the results were not statistically significant. Positive correlations among adropin and androstenedione levels were observed in the PCOS group (r = 0.27, p = 0.025). CONCLUSIONS: Women with PCOS have a different metabolic profile in comparison to women without this syndrome. We did not observe a statistically significant difference in adropin concentration between the PCOS and the healthy control group. Therefore, more studies regarding adropin in PCOS are needed.

Accumulation of abdominal fat in relation to selected proinflammatory cytokines concentrations in non-obese Wroclaw inhabitants.

INTRODUCTION: Metabolically obese normal weight (MONW) subjects, despite their normal BMI, present metabolic disturbances characteristic of abdominal obesity. One of the reasons might be subclinical inflammation caused by the fat tissue excess. The aim of this study was to assess the association between the accumulation of fat (especially abdominal) and the concentration of selected proinflammatory cytokines - interleukins (IL-6, IL-18) and C-reactive protein (CRP). MATERIAL AND METHODS: The study population consisted of 342 subjects (218 women, 124 men; age 20-40 years, BMI < 27 kg/m2) recruited from a community centre in Wroclaw. The group was divided based on the homeostasis assessment insulin resistance index (HOMA) value: 90 MONW subjects with HOMA > 1.69 and 252 subjects as control group. Anthropometric parameters, serum IL-6, IL-18, CRP, glucose, insulin concentrations and insulin sensitivity/resistance indexes were evaluated. RESULTS: CRP levels were significantly higher (3.26 vs. 1.97, p = 0.03) in MONW women than in the control group. Serum IL-6, IL-18 levels in males and females did not differ in both groups. IL-6 showed a significant correlation with the abdominal to gynoidal fat tissue deposit ratio in women. There were correlations between the CRP and BMI, WHR, waist circumference, total fat, abdominal fat deposit, and abdominal to gynoidal fat deposit ratio in both sexes. In women, positive correlations between CRP and HOMA, FIRI and negative with QUICKI index were present. CONCLUSIONS: Increased accumulation of abdominal adipose tissue in non-obese, young and healthy subjects is related to increased CRP levels.

Evaluation of the prevalence of metabolic obesity and normal weight among the Polish population.

INTRODUCTION: In the 1980s, the idea evolved that some individuals with normal weight (Metabolically Obese, Normal-Weight), who probably have increased abdominal fat, have metabolic disturbances related to obesity. This observation initiated the concept of the metabolically obese but normal-weight syndrome (MONW). Since then, there have been only a few studies in non-obese subjects. MONW men and women should be regarded as at high risk for cardiovascular disease. MATERIAL AND METHOD: A group of 854 randomly chosen non-obese men and women, 20-40 years of age, was selected from three different areas of Poland - Szczecin, Krakow and Wroclaw. All subjects were interviewed and underwent physical examination, anthropometric measurements (waist circumference, hip circumference, BMI and WHR) as well as densitometry (total body DPX, total fat, android/gynoid deposit). Serum level of fasting glucose and insulin, indices of insulin sensibility (QUICKI) and insulin resistance (HOMA, FIRI), total cholesterol, triglycerides and HDL-C were measured using commercially available kits. LDL-C level was calculated using Friedewald's formula. RESULTS: The total amassed fatty tissue and its android deposit was found to be significantly greater in MONW men and women. MONW women were found to exhibit increased levels of triglycerides and LDL-C but lower levels of HDL-C. In women with excess abdominal fat (EAF), fasting glucose and insulin levels, HOMA and FIRI were considerably higher, while QUICKI was lower. Triglyceride and LDL-C levels were also higher while HDL-C levels were lower. In men with EAF, increased levels of total cholesterol and LDL-C were confirmed. CONCLUSIONS: The occurrence of MONW is contingent upon the diagnosis criterion and increases when the criterion represents the value of HOMA - 21.76% in women and 31.42% in men. The frequency of MONW occurrence is lower when the criterion for abdominal fat content limit is used, amounting to 15.78% in women and 7.83% in men.