Prognostic Value of Non-HDL Cholesterol in COVID-19 Pneumonia. / Valor Prognóstico do Colesterol não HDL na Pneumonia por COVID-19.

BACKGROUND: In addition to coronary artery disease, non-high-density lipoprotein(non-HDL-C) provides short and long-term predictive information for many chronic inflammatory diseases such as stroke, hemodialysis, post-renal transplant, non-alcoholic hepatosteatosis, and human immunodeficiency virus. OBJECTIVES: This study examined the predictive value of non-HDL-C measured before SARS-CoV-2 for mortality in COVID-19 infection. METHODS: This study retrospectively included 1435 patients diagnosed with COVID-19 and treated in the thoracic diseases ward in a single center between January 2020 and June 2022. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by a polymerase chain reaction studied from an oropharyngeal swab. Statistical significance was set at p < 0.05. RESULTS: The study patients, including 1435 subjects, were divided into 712 patients in the non-surviving group and 723 in the surviving group. While there was no difference between the groups regarding gender, there was a statistically significant age difference. The non-surviving group was older. Age, lactate dehydrogenase(LDH), C reactive protein(CRP), triglycerides, D-dimer, and non-HDL-C were independent risk factors for mortality in regression analyses. In correlation analysis, age, CRP, and LDH were positively correlated with non-HDL-C. In the ROC analysis, sensitivity for non-HDL-C was 61.6%, and specificity was 89.2%. CONCLUSION: We believe that the non-HDL-C level studied before COVID-19 infection can be used as a prognostic biomarker for the disease.

FUNDAMENTO: Além da doença arterial coronariana, a lipoproteína de não alta densidade (não-HDL-C) fornece informações preditivas de curto e longo prazo para muitas doenças inflamatórias crônicas, como acidente vascular cerebral, hemodiálise, pós-transplante renal, hepatoesteatose não alcoólica e vírus da imunodeficiência humana. OBJETIVOS: Este estudo examinou o valor preditivo do não-HDL-C medido antes do SARS-CoV-2 para mortalidade na infecção por COVID-19. MÉTODOS: Este estudo incluiu retrospectivamente 1.435 pacientes diagnosticados com COVID-19 e tratados na enfermaria de doenças torácicas em um único centro entre janeiro de 2020 e junho de 2022. Todos os pacientes incluídos no estudo apresentavam características clínicas e radiológicas e sinais de pneumonia por COVID-19. O diagnóstico de COVID-19 de todos os pacientes foi confirmado por uma reação em cadeia da polimerase estudada a partir de um swab orofaríngeo. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: Os pacientes do estudo, incluindo 1.435 indivíduos, foram divididos em 712 pacientes no grupo de não sobreviventes e 723 no grupo de sobreviventes. Embora não tenha havido diferença entre os grupos em relação ao sexo, houve uma diferença de idade estatisticamente significativa. O grupo que não sobreviveu era mais velho. Idade, lactato desidrogenase (LDH), proteína C reativa (PCR), triglicerídeos, D-dímero e não-HDL-C foram fatores de risco independentes para mortalidade em análises de regressão. Na análise de correlação, idade, PCR e LDH foram positivamente correlacionados com não-HDL-C. Na análise ROC, a sensibilidade para não-HDL-C foi de 61,6% e a especificidade foi de 89,2%. CONCLUSÃO: Acreditamos que o nível de não HDL-C estudado antes da infecção por COVID-19 pode ser usado como um biomarcador prognóstico para a doença.

The effect of hemodialysis on the body composition and cardiovascular disease markers in recently diagnosed end stage renal disease patients.

AIM: Uremic toxins and excess fluid contributes to increased cardiovascular (CV) risk. We aimed to determine the body fluid status in patients who are just starting hemodialysis (HD) and to determine the effects of excess fluid removed by HD on the CV system. METHODS: A total of 52 patients with chronic kidney disease (CKD) who had just started HD were included. Before the HD, the left atrial diameter was measured, the volumes were calculated, the pulse wave velocity (PWV) and the augmentation index (AIx) were measured, the bioimpedance analysis (BIA) was performed, the blood was taken for brain natriuretic peptide (BNP). When patients reached their dry weight with HD, the same measurements were repeated. RESULTS: Measurements were made to determine the volume status, and all parameters except the fat tissue index decreased significantly after HD. With the removal of fluid by HD, there was an average weight reduction of 4.38 kilograms. Positive correlations between PWV and age and cardiothoracic ratio (CTR) before HD were determined. Negative correlations were found between PWV and lean tissue mass (LTM) and intracellular water (ICW) before HD. At the end of the last HD, PWV was positively correlated with age, CTR, central pulse pressure Correlation between pulse wave velocity and LTI was negative. CONCLUSIONS: HD significantly improves PWV in patients reaching dry weight. Reduction of fluid excess by ultrafiltration in HD patients may reduce CV mortality by reducing arterial stiffness.

The effect of hemodialysis on the body composition and cardiovascular disease markers in recently diagnosed end stage renal disease patients

SUMMARY AIM: Uremic toxins and excess fluid contributes to increased cardiovascular (CV) risk. We aimed to determine the body fluid status in patients who are just starting hemodialysis (HD) and to determine the effects of excess fluid removed by HD on the CV system. METHODS: A total of 52 patients with chronic kidney disease (CKD) who had just started HD were included. Before the HD, the left atrial diameter was measured, the volumes were calculated, the pulse wave velocity (PWV) and the augmentation index (AIx) were measured, the bioimpedance analysis (BIA) was performed, the blood was taken for brain natriuretic peptide (BNP). When patients reached their dry weight with HD, the same measurements were repeated. RESULTS: Measurements were made to determine the volume status, and all parameters except the fat tissue index decreased significantly after HD. With the removal of fluid by HD, there was an average weight reduction of 4.38 kilograms. Positive correlations between PWV and age and cardiothoracic ratio (CTR) before HD were determined. Negative correlations were found between PWV and lean tissue mass (LTM) and intracellular water (ICW) before HD. At the end of the last HD, PWV was positively correlated with age, CTR, central pulse pressure Correlation between pulse wave velocity and LTI was negative CONCLUSIONS: HD significantly improves PWV in patients reaching dry weight. Reduction of fluid excess by ultrafiltration in HD patients may reduce CV mortality by reducing arterial stiffness.

RESUMO INTRODUÇÃO: Em pacientes com doença renal crônica (DRC), toxinas urêmicas e hipervolemia contribuem para aumentar o risco cardiovascular. Nosso objetivo foi determinar o estado de hidratação em pacientes com DRC iniciando hemodiálise (HD) e avaliar os efeitos da correção da hipervolemia sobre o sistema cardiovascular. MÉTODOS: Foram incluídos 52 pacientes que haviam acabado de iniciar HD. Antes do início da sessão, foram determinados o diâmetro e o volume atrial esquerdo, a velocidade de onda de pulso (VOP) e o índice de amplificação sistólica ("augmentation index", AI). Além disso, realizamos análise da composição corporal por bioimpedância elétrica (BIA) e mensuramos os níveis plasmáticos de peptídeo natriurético tipo B. Os mesmos procedimentos foram repetidos após os pacientes alcançarem o "peso seco". RESULTADOS: O peso corporal dos pacientes foi reduzido, em média, em 4,38 kg. Na BIA, todos os parâmetros, exceto o índice de gordura corporal, foram significativamente reduzidos após a hemodiálise. Antes da HD, a VOP se correlacionou positivamente com idade e razão cardiotorácica (RCT), e negativamente com a massa magra e a água intracelular. Ao final da hemodiálise, a VOP se correlacionou positivamente com idade, RCTe pressão de pulso central, correlacionando-se negativamente com a Lean Tissue Index (LTI). CONCLUSÃO: A hemodiálise melhora a VOP por meio da redução da volemia. O controle da hipervolemia via ultrafiltração pode reduzir a mortalidade cardiovascular por meio da redução da rigidez arterial.