TNF Inhibitors Exert a "Hidden" Beneficial Effect in the Cardiovascular Lipoprotein Profile of RA Patients.

Purpose: A high cardiovascular risk has been described in patients with rheumatoid arthritis (RA); the effects of different biological agents have also been described in these patients. The aim of the present study is to examine the effects of tumor necrosis factor inhibitors (TNFi) in the lipoprotein profile of RA patients using a broad laboratory assessment including a large number of non-routine tests. Patients and Methods: RA patients treated with and without TNFi (70 patients in each group) were cross-sectionally compared regarding a broad spectrum of lipoprotein parameters including serum levels of total and HDL, LDL and VLDL cholesterol triglycerides, lipoprotein A (LpA), apolipoprotein A1 (Apo A), B100 (Apo B) and paroxonase. For each lipoprotein subfraction (HDL, LDL and VLDL), we assess specific concentrations of cholesterol, triglycerides, phospholipids and proteins and total mass of each one. Additionally, HDL Apo A, LDL and VLDL Apo B concentrations and number of particles of LDL and VLDL were also determined. Exploratory univariate and multivariate analyses of the different variables were performed. Results: Seventy patients in each subset were enrolled. Patients on treatment with TNFi showed a trend to be younger and to have a longer disease duration. Regarding the lipoprotein analyses, borderline significant higher levels of serum Apo A were detected and an independent association with lower HDL mass, LDL triglyceride, VLDL cholesterol, VLDL Apo B, VLDL mass, number of VLDL cholesterol molecules and number of particles of VLDL was clearly observed. Conclusion: TNFi treatment was associated with beneficial atherogenic effects at the lipoprotein level especially centered in the VLDL-related parameters consistent with a reduction of the atherogenic risk.

Improvement of serum lipids concentration in a general population historical cohort. Why? / Mejora de la concentración de lípidos séricos en una cohorte histórica de población general. ¿Por qué?

Background: Knowledge about the harmful effects of high levels of low-density lipoprotein cholesterol (cLDL) in adults increased after the publication of various guidelines, leading to closer control and more treatment. We hypothesized that these health care changes would result in an overall improvement in the lipid profile of the population. Objective: To determine the evolution of the lipid profile in the population of Spain from the Diet and Risk of Cardiovascular Disease in Spain cohort. Methods: A comparison was made between the baseline population-based probabilistically sampled DRECE cohort (DRECE 1 study, 1992-1994, n=4787) and its 13 years later revisit (DRECE 3 study, 2005-2007). A cross-sectional comparison was made of the overall population of DRECE1 and DRECE3, including only individuals aged 20 to 60 years (inter-individual variations). For subjects participating in both DRECE1 and DRECE3 (n=1039), individual variations over time (intra-individual analyses) were examined. Results: In the overall population, the prevalence of lipid-lowering therapy increased from 3.8% in DRECE1 to 10.7% in DRECE3. Comparing the lipid profile of the population aged 20-60 years in DRECE1 with the same age group in DRECE3, an overall decrease is observed in total cholesterol from a mean of 203.31mg/dl (SD 43.51) in 1992-1994 to 196.31mg/dl (SD 38.53) in 2005-2007, and in cLDL from a mean of 125.78mg/dl (SD 38.53) to 121.37mg/dl (SD 34.22). The proportion of the population with total cholesterol >200mg/dl decreased from 51% in DRECE1 to 47% in DRECE3, although this difference did not reach statistical significance (p=0.077). As regards the intra-individual analyses, total cholesterol increased from DRECE1 to DRECE3 in men and women younger than 40 years at baseline, but decreased in those who were older. Index of individuality for total cholesterol, cLDL, cHDL and triglycerides ranged from 0.53 to 0.87. Conclusions: The lipid profile of the Spanish population improved between 1992-1994 and 2005-2007. Within individuals, lipid concentrations, especially total cholesterol and cLDL have increased, although the trend is favorable in the middle-age group (40-59 years). These changes seem to be due to several causes, impacted by dietary and lifestyle factors, and also by a greater emphasis in lipid-lowering therapy in middle-aged people. Lipid parameters had a low index of individuality, which limits their usefulness as population reference values (AU)

Antecedentes: Los efectos nocivos de los altos niveles de colesterol ligado a lipoproteínas de baja densidad (cLDL) han sido ampliamente difundidos en la literatura científica y popular. Nuestra hipótesis es que estas recomendaciones han influido eficazmente en el perfil lípido de la población española. Objetivo: Determinar la evolución del perfil de lípidos en la población de España a partir de la cohorte Dieta y riesgo de enfermedad cardiovascular en España (DRECE). Métodos: Se comparó la cohorte de partida DRECE (estudio DRECE1, 1992-1994, n=4.787), procedente de muestreo probabilístico poblacional, con su reevaluación a los 13 años (estudio DRECE3, 2005-2007). Se compararon de modo transversal las muestras DRECE1 y DRECE3, incluyendo solo sujetos entre 20 y 60 años (variaciones interindividuales). De los sujetos que participaron en ambos estudios (n=1.039) se examinaron las variaciones interindividuales a lo largo del tiempo (análisis intraindividual). Resultados: En la población general, la prevalencia de la terapia hipolipidemiante aumentó de 3,8% en DRECE1 a 10,7% en DRECE3. Al comparar el perfil lipídico de la población de 20 a 60 años en DRECE1 con el mismo grupo de edad en DRECE3 disminuye la media del colesterol total de 203,31mg/dl (DS 43,51) en 1992-1994 a 196,31mg/dl (DS 38,53) en 2005-2007, la media del cLDL disminuye de 125,78mg/dl (DS 38,53) a 121,37mg/dl (DS 34,22). La proporción de la población con colesterol total>200mg/dl se redujo de 51% en DRECE1 al 47% en DRECE3, aunque esta diferencia no fue significativa (p=0,077). Respecto del análisis intraindividual el colesterol total aumentó de DRECE1 a DRECE3 en hombres y mujeres menores de 40 años al inicio de la cohorte, y descendió en los mayores de 40. El índice de individualidad del colesterol total, cLDL, cHDL y triglicéridos osciló entre 0,53 y 0,87. Conclusiones: El perfil lipídico de la población española mejoró entre 1992-1994 y 2005-2007. La concentración intraindividual de lípidos aumentó ligeramente, especialmente el colesterol total y cLDL, pero la tendencia fue más favorable en los sujetos de edad media (40-59 años). Estos cambios parecen ser multicausales, influidos por factores dietéticos y de estilo de vida, y también por un mayor énfasis en la terapia hipolipidemiante en sujetos en edad media. Los parámetros lipídicos tenían un bajo índice de individualidad, lo que limita su utilidad como valores de referencia poblacionales (AU)

Improvement of serum lipids concentration in a general population historical cohort. Why?

BACKGROUND: Knowledge about the harmful effects of high levels of low-density lipoprotein cholesterol (cLDL) in adults increased after the publication of various guidelines, leading to closer control and more treatment. We hypothesized that these health care changes would result in an overall improvement in the lipid profile of the population. OBJECTIVE: To determine the evolution of the lipid profile in the population of Spain from the Diet and Risk of Cardiovascular Disease in Spain cohort. METHODS: A comparison was made between the baseline population-based probabilistically sampled DRECE cohort (DRECE 1 study, 1992-1994, n=4787) and its 13 years later revisit (DRECE 3 study, 2005-2007). A cross-sectional comparison was made of the overall population of DRECE1 and DRECE3, including only individuals aged 20 to 60 years (inter-individual variations). For subjects participating in both DRECE1 and DRECE3 (n=1039), individual variations over time (intra-individual analyses) were examined. RESULTS: In the overall population, the prevalence of lipid-lowering therapy increased from 3.8% in DRECE1 to 10.7% in DRECE3. Comparing the lipid profile of the population aged 20-60 years in DRECE1 with the same age group in DRECE3, an overall decrease is observed in total cholesterol from a mean of 203.31mg/dl (SD 43.51) in 1992-1994 to 196.31mg/dl (SD 38.53) in 2005-2007, and in cLDL from a mean of 125.78mg/dl (SD 38.53) to 121.37mg/dl (SD 34.22). The proportion of the population with total cholesterol >200mg/dl decreased from 51% in DRECE1 to 47% in DRECE3, although this difference did not reach statistical significance (p=0.077). As regards the intra-individual analyses, total cholesterol increased from DRECE1 to DRECE3 in men and women younger than 40 years at baseline, but decreased in those who were older. Index of individuality for total cholesterol, cLDL, cHDL and triglycerides ranged from 0.53 to 0.87. CONCLUSIONS: The lipid profile of the Spanish population improved between 1992-1994 and 2005-2007. Within individuals, lipid concentrations, especially total cholesterol and cLDL have increased, although the trend is favorable in the middle-age group (40-59 years). These changes seem to be due to several causes, impacted by dietary and lifestyle factors, and also by a greater emphasis in lipid-lowering therapy in middle-aged people. Lipid parameters had a low index of individuality, which limits their usefulness as population reference values.

Clinical, biochemical and genetic spectrum of low alkaline phosphatase levels in adults.

BACKGROUND: Low serum levels of alkaline phosphatase (ALP) are a hallmark of hypophosphatasia. However, the clinical significance and the underlying genetics of low ALP in unselected populations are unclear. METHODS: In order to clarify this issue, we performed a clinical, biochemical and genetic study of 42 individuals (age range 20-77yr) with unexplained low ALP levels. RESULTS: Nine had mild hyperphosphatemia and three had mild hypercalcemia. ALP levels were inversely correlated with serum calcium (r=-0.38, p=0.012), pyridoxal phosphate (PLP; r=-0.51, p=0.001) and urine phosphoethanolamine (PEA; r=-0.49, p=0.001). Although many subjects experienced minor complaints, such as mild musculoskeletal pain, none had major health problems. Mutations in ALPL were found in 21 subjects (50%), including six novel mutations. All but one, were heterozygous mutations. Missense mutations were the most common (present in 18 subjects; 86%) and the majority were predicted to have a damaging effect on protein activity. The presence of a mutated allele was associated with tooth loss (48% versus 12%; p=0.04), slightly lower levels of serum ALP (p=0.002), higher levels of PLP (p<0.0001) and PEA (p<0.0001), as well as mildly increased serum phosphate (p=0.03). Ten individuals (24%) had PLP levels above the reference range; all carried a mutated allele. CONCLUSION: One-half of adult individuals with unexplained low serum ALP carried an ALPL mutation. Although the associated clinical manifestations are usually mild, in approximately 50% of the cases, enzyme activity is low enough to cause substrate accumulation and may predispose to defects in calcified tissues.

Estimated Glomerular Filtration Rate in Renal Transplantation: The Nephrologist in the Mist.

BACKGROUND: Formulas do not estimate renal function with acceptable precision and accuracy. METHODS: We compared 51 creatinine-based and/or cystatin c-based formulas with a gold standard (iohexol plasma clearance) in 193 renal transplant recipients using concordance correlation coefficient, total deviation index, coverage probability and the error in chronic kidney disease (CKD) stage classification. RESULTS: No formula showed a concordance correlation coefficient greater than 0.90 (average for creatinine-based formulas: ∼0.70 and for cystatin c-based formulas: ∼0.85). A wide total deviation index was observed: approximately 70% (creatinine-based) and approximately 50% (cystatin c-based), indicating that 90% of the estimations showed bounds of error of ±70% or ±50%, respectively, compared with the gold standard. No formula included 90% of the estimations within a coverage probability of ±10%. Half the CKD stages classified by creatinine-based formulas were incorrect, mainly due to overestimation of renal function. One of 3 CKD stages diagnosed by cystatin c-based formulas was incorrect, with both overestimation and underestimation. Overall, the formulas showed very low precision and accuracy and a high degree of error in reflecting real renal function. CONCLUSIONS: In conclusion, formulas do not properly reflect renal function in kidney transplantation, which makes their use in clinical practice unreliable. Moreover, their use in clinical trials should be avoided.

Influencia de la inflamación y la presencia de amiloide sobre el metabolismo lipídico en pacientes con artritis reumatoide / No disponible

Introducción Los pacientes con artritis reumatoide (AR) presentan una aterosclerosis acelerada, que se ha relacionado en parte con alteraciones del metabolismo lipídico asociadas al proceso inflamatorio, que incluye a la proteína sérica amiloide A. Objetivo Evaluar el perfil lipídico en pacientes con AR tratada y su relación con la actividad inflamatoria y la presencia de amiloidosis secundaria. Métodos Se estudiaron 78 pacientes mujeres con AR. A todas se les realizó una extracción sanguínea para analizar el perfil lipídico (colesterol total, c-HDL, c-HDL3, c-HDL2, c-LDL, triglicéridos, lipoproteína(a) y (..) (AU)

Introduction Patients with rheumatoid arthritis (RA) display an accelerated atherosclerosis that is related in part to lipid metabolism disorders associated with the inflammatory process, which includes serum amyloid protein A. Objective To evaluate the lipid profile in treated RA patients and its relationship to inflammatory activity and the presence of secondary amyloidosis.

¿Podemos utilizar la apolipoproteína B en la toma de decisiones para la intervención en el riesgo cardiovascular de pacientes con triglicéridos elevados? / Can apolipoprotein B be used for making decisions on cardiovascular risk prevention in patients with raised triglycerides?

Objetivo. Analizar el valor predictivo de diversas aproximaciones: cuantificación de la concentración de apolipoproteína B (apoB), estimación del cLDLf y estimación del no-cHDL, como predictivos de elevaciones de la magnitud de la concentración de cLDL. Material y métodos. Estudio multicéntrico transversal en el que se han analizado las muestras rutinarias de 6.094 pacientes consecutivos. En cada paciente se ha cuantificado el cLDL mediante una técnica de ultracentrifugación de rutina (cLDLu) y la concentración de apoB por uno de los métodos inmunológicos estandarizados y se ha estimado el cLDLf y el no-cHDL. Las magnitudes obtenidas han sido utilizadas para analizar sus valores predictivos del cLDLu en función de tres grupos de concentración de Tg (<200, entre 200 y 400 y más de 400mg/dL) y los grupos de riesgo definidos por el ATPIII (cLDL>70, 100, 130 o 160mg/dL). Resultados y conclusiones. Con todas las magnitudes analizadas se obtiene un buen valor predictivo positivo, variable para las diferentes concentraciones de Tg y que es máximo para la apoB con puntos de corte de alta especificidad (AE). Las estimaciones con cLDLf infraestiman la situación de riesgo del paciente, mientras que las que utilizan el no-cHDL la sobreestiman. Conclusión. En pacientes con Tg<200mg/dL puede utilizarse prácticamente sin riesgo la fórmula de Friedewald; en pacientes con Tg elevados es recomendable la apoB (puntos de corte de AE) como predictor positivo y el no-cHDL como predictor negativo (AU)

Objective. To analyse the predictive value of several approaches to cardiovascular risk prevention: measuring apolipoprotein B concentrations (apoB), estimation of fractionated LDL cholesterol (cLDLf) and non-HDL cholesterol (HDLc), to predict increases in LDL cholesterol. Material and Methods. Cross-sectional multicentre study in which routine samples from 6094 consecutive patients were analysed. In each patient, LDLc was quantified by routine ultracentrifugation technique (LDLu) and apoB concentrations by a standard immunological method. We also estimated the LDLf and non-HDLc. The values obtained were used to analyse the predictive values of unfractionated LDL cholesterol (cLDLu) into three groups according to their triglyceride concentration (<200, between 200 and 400 and 400mg/dL) and risk groups as defined by the Adult Treatment Panel (ATP) III guidelines (LDL-C> 70, 100, 130 or 160mg/dL). Results and conclusions. With all the variables analysed we obtained a good positive predictive value, which varied according to the triglyceride concentrations, with the highest values being obtained for apoB with high specificity cut-off points (AE). Calculations with LDLf values underestimate the patient's risk, while those using non-HDLc overestimate it. Conclusion. The Friedewald formula can be used practically without risk in patients with triglycerides below 200mg/dL. In patients with elevated triglycerides, apoB (AE cut-off points) is recommended as a positive predictor, and non-HDLc as a negative predictor (AU)

Evaluación multicéntrica de distintos métodos para la determinación de colesterol HDL directo con respecto al colesterol HDL de precipitación / Multicentre evaluation of different methods for the determination of direct HDL-cholesterol compared to the precipitation method

Introducción. Los resultados de los programas de garantía de calidad indican que existen diferencias significativas entre los métodos homogéneos disponibles para la medición del colesterol HDL. Sin embargo, la posible influencia de efectos matriz en las muestras liofilizadas empleadas y la ausencia de un valor verdadero en estas muestras, hace difícil la valoración completa de estos métodos. En este estudio experimental multicéntrico hemos comparado los métodos homogéneos más utilizados en nuestro medio, con respecto al de precipitación de ácido fosfotúngstico-MgCl2. Material y métodos. Cada laboratorio procesó unas 100 muestras de suero de pacientes por uno o dos métodos homogéneos y envió alícuotas congeladas de las muestras analizadas al laboratorio central donde se procesaron por el método de precipitación. Resultados. Las imprecisiones de los métodos homogéneos fueron buenas e inferiores a las de precipitación, que cumplía las especificaciones de calidad para sesgo y error total (ET). Sin embargo, no todos los métodos homogéneos cumplían los objetivos de calidad mínimos, pues algunos procedimientos producían sesgos positivos muy altos (en relación al método de comparación) y uno un sesgo negativo muy bajo. El estudio de la concordancia, realizado estratificando a los pacientes según las concentraciones de colesterol HDL, mostró diferencias entre los métodos. Conclusiones. Estos resultados sugieren que existen discrepancias en la valoración de las magnitudes obtenidas con los métodos homogéneos, probablemente generada por una elevada inexactitud en algunos de ellos y que es conveniente que los laboratorios conozcan las caracteristicas de imprecisión y sesgo del metodo directo que utilizan con respecto al de referencia (AU)

Introduction. The results of quality assurance programs suggest that there are significant differences between the homogeneous methods available for the measurement of HDL cholesterol. However, the possible influence of matrix effects in the lyophilized samples used and the absence of a true value in these samples means that a full assessment of these methods cannot be made. In this multicentre pilot study we compared the most used homogeneous methods in our country with the phosphotungstic acid-MgCl2 method. Material and methods. Each laboratory processed about one hundred serum samples from patients with one or two homogeneous methods and sent frozen aliquots of the samples in special packaging with dry ice to the central laboratory where they were processed by the precipitation method. Results. The imprecision of homogeneous methods were good and lower than those of the precipitation method, and met the quality specifications for bias and total error (TE). However, not all homogeneous methods met the minimum quality objectives, as some procedures produced a very high positive bias (relative to the comparison method) and one, a low negative bias. In addition, the study of the agreement between methods, made by stratifying patients according to HDL cholesterol concentrations, showed differences. Conclusions. These results suggest that there are discrepancies in the assessment of the levels obtained with homogeneous methods, probably due to a high inaccuracy in some of them, and it is advised that the laboratories be aware of the characteristics of inaccuracy and bias of the direct method used compared to the reference method (AU)

Concentraciones séricas de marcadores bioquímicos en pacientes intervenidos de derivación biliopancreática / Serum biochemical markers in patients with biliopancreatic diversion

Introducción. La derivación biliopancreática (DBP) es una intervención malabsortiva por lo que es muy frecuente la aparición de deficiencias nutricionales, además suele ser necesaria la suplementación tras la cirugía. Material y Métodos. Se compararon las concentraciones de marcadores bioquímicos que reflejan el estado nutricional de 53 controles y 28 pacientes sometidos a DBP en distintos tiempos tras la intervención (seis meses, al año, cinco y siete años). Además, se evaluaron las principales comorbilidades asociadas a la obesidad. Resultados. La distribución por sexos del estudio fue del 86% y 72% de mujeres, para el grupo estudiado y controles, respectivamente. La edad media, para el grupo de sujetos intervenidos fue de 41±10 años, y de 57±16 años para el grupo control. Se observó el mayor porcentaje de pérdida de peso a los 6 primeros meses, la pérdida se estabilizó a los 5 años de la intervención. Las comorbilidades asociadas más frecuentes fueron hipertensión y diabetes. Se obtuvieron diferencias inter- e intragrupos para vitaminas A y E, ácido fólico, vitamina D y paratohotmona, zinc y calcio, prealbúmina, hierro y hemoglobina, y para colesterol y fibrinógeno. Sin embargo, no se encontraron para vitamina B12, magnesio, proteínas totales y albúmina, ferritina, transferrina y hematocrito, ni para homocisteina. Conclusión. Los pacientes intervenidos de DBP presentan déficits notables de nutrientes y estas carencias suelen persistir a lo largo del tiempo por lo que la suplementación y el seguimiento exhaustivo deberían realizarse a largo plazo (AU)

Introduction. Biliopancreatic diversion (BPD) is a malabsorptive procedure which often leads to nutritional deficiencies and supplements should be given after surgery. Material and methods. We compared the concentrations of biochemical markers that reflect the nutritional status of 53 controls and 28 patients submitted to BPD at different times after the intervention (six months, one year, five, and seven years). Results. There were 86% and 72% women in the study and control groups, respectively. The mean age of the study subjects was 41±10 years, and 57±16 years for the control group. We observed the highest percentage of weight loss in the 6 first months. The weight loss became stable 5 years after the intervention. The most frequent associated comorbidities were hypertension and diabetes. Within and between group differences were obtained for vitamins A and E, folic acid, vitamin D and parathormone, zinc and calcium, prealbumin, iron and haemoglobin, and for total cholesterol and fibrinogen. Nevertheless, we did not found any differences for vitamin B12, magnesium, total proteins and albumin, ferritin, transferrin and haematocrit or for homocysteine. Conclusion. The patients operated on by BPD showed notable deficiencies of nutrients and these deficiencies often persist over time; for this reason the supplementation and the exhaustive follow-up should be long-term (AU)

Markers of inflammation before and during peritoneal dialysis.

In this study, we compared changes in inflammatory markers-C-reactive protein (CRP), pentraxin 3 (PTX3), serum component of amyloid A (SAA), and procalcitonin (PCT)-in 182 subjects: 69 from the general population (GP), 47 with CKD, 19 with an implanted intra-abdominal catheter for peritoneal dialysis ("prePD"), and 47 on peritoneal dialysis (PD). These were the results [median (95% confidence interval)] for the GP CKD, prePD, and PD groups respectively: CRP: 1.40 mg/L (1.15-2.10 mg/L), 5.30 mg/L (3.04-8.06 mg/L), 3.33 mg/L (2.15-12.58 mg/L), 7.25 mg/L (4.43-15.16 mg/L). SAA: 3.10 mg/L (2.90-3.53 mg/L), 7.77 mg/L (4.17-15.83 mg/L), 7.30 mg/L (4.81-10.96 mg/L), 9.14 mg/L (5.31-23.54 mg/L). PCT: 0.028 ng/mL (0.022-0.032 ng/mL), 0.121 ng/mL (0.094-0.166 ng/mL), 0.160 ng/mL (0.090-0.277 ng/mL), 0.363 ng/mL (0.222-0.481 ng/mL). PTX3: 0.54 ng/mL (0.33-0.62 ng/mL), 0.71 ng/ mL (0.32-1.50 ng/mL), 0.56 ng/mL (0.44-1.00 ng/ mL), 1.04 ng/mL (0.65-1.56 ng/mL). After catheter insertion, CRP showed a nonsignificant declining trend that disappeared throughout PD. The behavior of SAA was similar to that of CRP and was not modified by the changes induced by the start of PD. An increase in PTX3 was observed only with PD, which may be related to a local proinflammatory state caused by PD solution. We can conclude that catheter insertion for PD does not account for most of the local inflammatory changes observed in PD patients.

Inflammation markers, chronic kidney disease, and renal replacement therapy.

Chronic kidney disease (CKD) is associated with a proinflammatory state and an excess of cardiovascular risk. In this work, we describe changes in inflammatory markers-C-reactive protein (CRP), pentraxin 3 (PTX3), serum component of amyloid A (SAA), and procalcitonin (PCT)--in CKD patients compared with a control group of subjects with a normal estimated glomerular filtration rate (eGFR). Blood samples were obtained from 69 healthy individuals (GP) and 70 end-stage CKD patients--25 not yet on dialysis, 22 on peritoneal dialysis (PD), and 23 on hemodialysis (HD). These were the results [median (95% confidence interval)] for the GP CKD, PD, and HD groups respectively: CRP: 1.40 mg/L (1.19-2.11 mg/L), 6.50 mg/L (3.57-8.32mg/L), 7.60 mg/L (2.19-22.10mg/L), 9.60 mg/L (6.62-16.38 mg/L). SAA: 3.10 mg/L (2.90-3.53 mg/L), 7.11 mg/L (3.81-15.40mg/L), 9.69 mg/L (5.07-29.47mg/L), 15.90 mg/L (6.80-37.48 mg/L). PCT: 0.03 ng/mL (0.02-0.03 ng/mL), 0.12 ng/mL (0.09-0.16 ng/mL), 0.32 ng/mL (0.20-0.46 ng/ mL), 0.79 ng/mL (0.45-0.99 ng/mL). PTX3: 0.54 ng/mL (0.33-0.62 ng/mL), 0.71 ng/ mL (0.32-1.50 ng/mL), 1.52 ng/mL (0.65-2.13 ng/mL), 1.67 ng/mL (1.05-2.27 ng/mL). Compared with levels in the GP group, levels of SAA and CRP (systemic response) were significantly higher in CKD patients on and not on dialysis. Levels of PTX3 were higher only in dialyzed patients, significantly so in those on HD (greatly different from the CRP levels). These differing levels might be related to a local reaction caused by an invasive intervention (PD or HD). As eGFR declines and with the start of renal replacement therapy, PCT increases. Levels of PCT could potentially cause confusion when these patients are being evaluated for the presence of infection, and may also demonstrate some microvascular implications of dialysis therapy.

Concentraciones séricas de vitaminas liposolubles y de zinc en pacientes sometidos a cirugía bariátrica / Serum concentrations of fat-soluble vitamins, zinc and other biochemical markers in patients after gastric or biliopancreatic bypass

Las vitaminas liposolubles y el zinc son micronutrientes que deben ser aportados con la dieta. Los bypass gástricos y biliopancreáticos son considerados intervenciones malabsortivas, pudiendo provocar importantes déficits carenciales. Material y métodos. Se compararon las concentraciones de vitaminas A y E, zinc y otros marcadores bioquímicos de 35 controles y 32 pacientes sometidos a cirugía bariátrica en distintos tiempos tras la intervención (tras seis meses, al año y transcurridos más de cinco años). Las determinaciones de las vitaminas y del zinc se realizaron mediante HPLC y por espectroscopia de absorción atómica por llama de aire-acetileno, respectivamente. Resultados. Para la vitamina A se obtuvieron medias de 2,15μmol/L en los controles. Los pacientes en los distintos tiempos tras la intervención mostraron valores decrecientes de vitamina A hasta alcanzar concentraciones de 0,63μmol/L tras más de cinco años de la cirugía (p<0,002). En el caso de la vitamina E se encontraron medias de 28,6 nmol/L para los controles y valores entre 11,7-15,6 nmol/L para los pacientes en las distintas etapas (p<0,001). En el caso del zinc se observaron medias de 11,6, 10,7 y 9,94μmol/L para los pacientes en los distintos tiempos, encontrándose diferencias significativas con los controles (p<0,001). Además, se observó significación estadística en las concentraciones de calcio, hierro y folato. Conclusiones. Los pacientes intervenidos de cirugía bariátrica presentan problemas absortivos con déficits notables de nutrientes por lo que este hecho debería ser considerado a efectos de evitar posibles patologías derivadas de estas carencias (AU)

Introduction: Fat-soluble vitamins and zinc are substances not synthesized in the body. Consequently intake of those micronutrients is required. Gastric and biliopancreatic bypass considered malabsorption interventions that can lead to nutritional deficiencies. Material and methods: We compared levels of vitamins A and E, zinc and others biochemical markers of 35 controls and 32 patients submitted to bariatric surgery at different times after the operation (after six months, after one year and after more than five years). Vitamins and zinc were determined by HPLC and air-acetylene flame atomic absorption, respectively. Results: A mean of 2.15 mol/L was obtained for controls. In the different times after the surgery, the patients showed decreasing values of vitamin A up to concentrations of 0.63 mol/L after more than five years after the intervention (P < .002). For vitamin E, a mean 28.6 nmol/L was obtained for controls, and values between 11.7-15.6 nmol/L for patients at the different times after the surgery (P < -001). Means of 11.6, 10.7 and 9.9 mol/L of zinc were observed in patients at the different times, being significantly different from the control group (P < .001). In addition, we found statistical significance in the concentration of calcium, iron and folic acid. Conclusions: Patients after bariatric surgery show absorption problems with a marked lack of nutrients. This fact should be taken into consideration to reduce effects of possible pathologies derived from these deficiencies (AU)

Factores de riesgo emergentes / Emergent risk factors

No disponible

No disponible

Evaluación de la capacidad diagnóstica y pronóstica de procalcitonina, proteína C reactiva, interleucina-6 y proteína ligadora del lipopolisacárido en pacientes con sospecha de sepsis / Evaluation of the diagnostic and prognostic capacity of procalcitonin, C reactive protein, interleukin-6 and lipopolysaccharide binding protein in patients suspected of having sepsis

Objetivo. Evaluar la capacidad de procalcitonina (PCT), proteína C reactiva (PCR), interleucina-6 (IL-6) y proteína ligadora del lipopolisacárido (LBP), para discriminar entre sepsis y síndrome de respuesta inflamatoria sistémica (SIRS) de origen no infeccioso, y para predecir el riesgo de desarrollar shock séptico o muerte. Material y métodos. Estudio prospectivo de cohortes observacional. Población de 191 pacientes con SIRS (115 varones y 76 mujeres; edad media: 62±19). En todos ellos se analizó la concentración de PCR, PCT, IL-6 y LBP. Resultados. Sólo IL-6 y PCT son capaces de diferenciar entre SIRS y sepsis. El análisis de las curvas ROC (Receiver Operating Characteristic) nos muestra que las áreas bajo la curva (AUC) más significativas fueron las de la PCT, con valores de 0,703 para sepsis (p=0,0001), de 0,707 para shock séptico (p=0,0001) y de 0,682 para muerte (p=0,0001), seguidas de las AUC de la IL-6 para sepsis, shock séptico y muerte, con valores de 0,692 (p=0,0001), 0,617 (p=0,0155) y 0,613 (p=0,022), respectivamente. Las AUC de PCR fueron de 0,631 (p=0,014) para sepsis, de 0,574 (p=0,127) para shock séptico y de 0,576 (p=0,123) en el caso de muerte. La LBP presenta una AUC de 0,612 (p=0,03) para sepsis. Los puntos de corte obtenidos para cada biomarcador a partir de las curvas ROC fueron de 109pg/ml, 584pg/ml y 1.769pg/ml en el caso de IL-6; de 17mg/ml, 56,8mg/ml y 54,1mg/ml para LBP; de 17,4mg/dl, 11mg/dl y 10,7mg/dl para PCR, y de 0,55ng/ml, 0,98ng/ml y 2,36ng/ml en el caso de la PCT para sepsis, shock séptico y muerte, respectivamente. Conclusiones. Tanto la PCT como la IL-6 fueron marcadores biológicos fiables en la detección de sepsis en nuestra población de pacientes con SIRS. La PCT resultó ser el mejor marcador de mala evolución (shock séptico o muerte) (AU)

Objective. To analyze the capacity of procalcitonin (PCT), C reactive protein (CRP), interleukin-6 (IL-6) and lipopolysaccharide binding protein (LBP) to discriminate between sepsis and systemic inflammatory response syndrome (SIRS) of non- infectious origin, and to predict the risk of developing septic shock or death. Material And Methods. Prospective cohorts observational study. Population of 191 patients with SIRS (115 men and 76 women; mean age 62±19). Blood levels of CRP, PCT, IL-6 and LBP were measured in all patients. Results. Only PCT and IL-6 were able to discriminate between SIRS and sepsis. The analysis of ROC (Receiver Operating Characteristic) curves show that the areas under the curve (AUC) were more significant in procalcitonin with values of 0.703 in the case of sepsis (P=0.0001), 0.707 for septic shock (P=0.0001) and 0.682 in case of death (P=0.0001), followed by the AUC of IL-6 for sepsis, septic shock and death with a value of 0.692 (P=0.0001), 0.617 (P=0.0155) and 0,613(P=0.022), respectively. The AUC of CRP were 0.631 (P=0.014) for sepsis, 0.574 (P=0.127) for septic shock and 0.576 with P=0.123 for death. LBP has an AUC of 0.612 (P=0.03) for sepsis. The cut points of each biomarker from the ROC curves were: 109pg/ml, 584pg/ml and 1769pg/ml for IL-6; 17mg/ml, 56.8mm/ml and 54.1mg/ml for LBP; 17.4mg/dl, 11mg/dl and 10.7mg/dl for CRP and 0.55ng/ml, 0.98ng/ml and 2.36ng/ml for PCT in the cases of sepsis, septic shock and death, respectively. Conclusion. Procalcitonin and interleukin 6 were good biological markers for the detection of sepsis in our population of patients with SIRS. PCT was the best biomarker of poor outcome (septic shock or death) (AU)

Causas principales de mortalidad precoz y exceso de mortalidad en la población diabética española. Estudio DRECE III / No disponible

No disponible

Evaluación de la troponina I en el analizador Pathfast(R) / Evaluation of the troponin I on the Pathfast(R) analyzer

Introducción. El Pathfast(R) (Mitsubishi Kagaku Iatron) es un analizador compacto de quimioinmunoluminiscencia que puede procesar indistintamente muestras de plasma y de sangre. Objetivos. En este estudio se han evaluado algunas características del procedimiento: repetibilidad, reproducibilidad, comparación con otro procedimiento (Dimension(R) RxL, Dade Behring), límite de detección, límite de cuantificación, interferentes endógenos por triglicérido, hemoglobina y bilirrubina, y tambien se ha estudiado la presencia de falsos positivos presentes en enfermedades sin isquemia miocárdica. Material y métodos. El diseño ha sido de un estudio multicéntrico en el que han participado los laboratorios de urgencias de 4 hospitales españoles. La magnitud biológica elegida para llevar a cabo esta evaluación ha sido la troponina I (TnI). Resultados. Los coeficientes de variación (CV) intradía fueron inferiores al 5%, mientras que los CV interdía no superaron el 10%. El límite de detección se situó entre 0,003 y 0,008ng/ml para los laboratorios participantes. El límite de cuantificación obtenido fue de 0,025ng/ml. La regresión obtenida entre suero y plasma fue de TnI (plasma)=−0,0008+0,9499×TnI (sangre), y la regresión obtenida con el método de comparación fue de TnI (Pathfast(R))=−0,0019+0,2903×TnI (Dimension(R) RxL). El estudio de interferencias endógenas muestra que los resultados no se alteran significativamente en presencia de triglicérido, bilirrubina o hemoglobina libre. El estudio de otras entidades clínicas (insuficiencia renal, accidente cerebrovascular y politraumatismo) no ha mostrado diferencias con el procedimiento de comparación. Discusión. En resumen, el analizador Pathfast® resulta un equipo fiable, preciso y fácil de manejar, útil para laboratorios de tamaño pequeño y medio, o para laboratorios de urgencias (AU)

Introduction. The Pathfast(R) (Mitsubishi Kagaku Iatron) is a compact chemiluminescent immunoassay analyser that is capable of processing either plasma or blood samples. Objectives. In this study we have evaluated some operational characteristics such as within assay variability, between-day variability, reference values, comparison with another method (Dimension® RxL, Dade Behring), analytical sensitivity, quantitation limits, endogenous interferences by triglycerides, haemoglobin and bilirubin, and false positives in other diseases. Materials and Methods. The evaluation of Troponin l was designed as a multicentre study in which the emergency laboratories of four Spanish Hospitals took part. Results. The within assay coefficient of variation (CV) was lower than 5% whereas the between-day CV did not exceed 10%. The overall analytical sensitivity for the four laboratories was between 0.003 and 0.008ng/ml. The quantitation limit was 0.025ng/ml. The regression obtained between plasma and blood was Troponin I (plasma)=−0.0008+0.9499×Troponin I (blood), and between Pathfast (R) and the comparison method was Troponin I (Pathfast)=−0.0019+0.2903×Troponin I (Dimension RxL). Tests of endogenous interferences showed that the results are not altered significantly in the presence of triglyceride, bilirubin or free haemoglobin. The study of other clinical diseases (Renal Impairment, Stroke, Multiple trauma) did not show any differences in the method comparison. Discussion. In summary, the Pathfast(R) analyser is reliable, precise and easy to handle, useful for laboratories of small and average size, or for emergency laboratories (AU)

Conventional lipid profile and lipoprotein(a) concentrations in treated patients with rheumatoid arthritis.

OBJECTIVE: Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk not completely explained by traditional cardiovascular risk factors. If the proatherogenic lipid profile observed in active and untreated RA improves by effectively treating RA without the use of a lipid-lowering agent, other nonconventional cardiovascular lipid risk factors may be implicated. We evaluated conventional lipid risk factors and lipoprotein(a) in treated patients with RA. METHODS: This cross-sectional study was conducted in 122 patients with RA. Lipid profiles of patients were compared with a control group, consisting of a population-based study cohort (DRECE study), matched for sex, age, menopausal status, and body mass index. Excess lipoprotein(a) was defined by a serum concentration > 0.3 g/l. RESULTS: High-density lipoprotein cholesterol (HDL-c) concentrations were higher in pre- and postmenopausal women with RA than in controls (p = 0.023 and p

[1991-2004 follow-up of a Spanish general population cohort. Mortality and raising risk factors in the DRECE III Study (Diet and Risk of Cardiovascular Diseases in Spain)]. / Seguimiento de 1991 a 2004 de la mortalidad y los factores de riesgo emergentes en una cohorte de población general española. Estudio Drece III (Dieta y Riesgo de Enfermedades Cardiovasculares en España).

BACKGROUND: The DRECE III study is based on the follow up of a cohort representative of the Spanish general population. The mortality, its main causes and relevant risk factors have been analyzed. METHODS: The DRECE cohort is composed of 4783 subjects followed since 1991 to 2004 (70930 person-years). In 1991 a general medical exam including blood analysis and nutritional questionnaire was undertaken. Currently the age spam is from 18 to 73 years. Vital status and mortality causes were provided by the National Institute of Statistics. RESULTS: In this period, 125 deaths were registered: 53 persons (42.4%) due to cancer; 31 persons (24.8%) due to circulatory causes, of which 24 were due to cardiovascular origin. The remaining 41 (32.8%) deaths were included under the ICD 10 "Other chapters". For the all causes mortality the independent associated variables were: creatinina 1.5 mgr/dl, HR 3.78 (95% CI: 1.52-9.40); diabetes, HR 2.80 (95% CI: 1.74-4.46); male sex, HR 2.39 (I95% CI: 1.61-3.55); age, HR 1.08 (I95% CI: 1.07-1.10); and gammaglutamil transpeptidasa, HR 1.001 (I95% CI: 1.000-1.003). In the case of cancer mortality the risk factors founded were: age, HR 1.12 (I95% CI: 1.09-1.16); and tobacco, HR 1.33 (I95% CI: 1.14-1.54). For cardiovascular mortality were creatinina 1.5 mg/dl, HR 19.40 (I95% CI: 5.45-69.12); diabetes, HR 9.82 (I95% CI: 4.19-23.04); and age, HR 1.10 (I95% CI: 1.05-1.15). CONCLUSIONS: We obtain a mortality pattern where cancer is the most frequent cause. Classic risk factors appear associated to main death causes. Diabetes mellitus has an outstanding role as risk factor associated to early mortality. No specific diet data was associated neither to all causes mortality, nor to cardiovascular or cancer.