Complex Levels In Patients Research Articles

Atacicept Reduces Serum Immune Complex Levels in Patients With IgA Nephropathy (IgAN)

Atacicept Reduces Serum Immune Complex Levels in Patients With IgA Nephropathy (IgAN)

NGAL/MMP-9 as a Biomarker for Epithelial Ovarian Cancer: A Case-Control Diagnostic Accuracy Study.

Background:Epithelial ovarian cancer (EOC) are often diagnosed late due to lack of specific symptoms and efficient tumor markers. Neutrophil gelatinase-associated lipocalin/matrix metallopeptidase-9 (NGAL/MMP-9) complex are involved in the development and progression of various cancers and have potential as a biomarker for diagnosing ovarian cancer.Objectives:To compare the serum NGAL/MMP-9 complex levels in patients with EOC, benign ovarian tumor, and healthy controls, and determine the potential cut-off values of NGAL/MMP-9 complex for diagnosing EOC.Materials and Methods:The study included 50 patients each with EOC and benign ovarian tumor, along with 50 age-matched healthy controls (N = 150). The level of serum NGAL/MMP-9 complex was estimated based on sandwich ELISA. The mean and median of the three groups were compared, and the ROC curve was used to determine the optimum cut-off, sensitivity, and specificity of serum NGAL/MMP-9 complex levels in the diagnosis of EOC.Results:A significant difference was found in the median values of the NGAL/MMP-9 complex (malignant EOC: 67.5 ng/ml, benign ovarian tumor: 53.7 ng/ml, controls: 29.2 ng/ml; P < 0.01). NGAL/MMP-9 complex level was also significantly associated with the FIGO staging (Stages I and II: 42.9 ng/ml; Stages III and IV: 70.5 ng/ml; P < 0.003). At a 55.0 ng/ml cut-off value, the NGAL/MMP-9 complex had 82.0% sensitivity and 78.0% specificity in diagnosing EOC.Conclusion:The NGAL/MMP-9 complex may be a promising biomarker for determining the progression of EOC as well as in detecting advanced-stage ovarian cancer.

Histone-DNA Complexes and Coagulation after Intracerebral and Subarachnoid Hemorrhage.

Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) have limited treatment options and a high mortality. We have previously shown that both conditions are associated with early hypercoagulation. 1 2 Histones have been demonstrated to promote thrombin generation. 3 In sepsis and trauma patients, studies have revealed an association between histone-DNA complexes and free histone levels and mortality or morbidity. 4 5 6 Theoretically, the effects on coagulation of histones can be investigated in vitro by attempting to block histones with specific antibodies. The aim of this study was to quantify histone-DNA complex levels in patients with ICH or SAH at the time of admission to hospital compared with 24 hours after symptom onset and to investigate the possible in vitro effect of anti-histone antibodies on thrombin generation.

Prevalence and Predictive Value of the Thrombin-Antithrombin Complex Levels in Patients with Abdominal Aortic Aneurysm and Peripheral Arterial Disease Undergoing Endovascular Interventions

Introduction: The level of activation of fibrynolitic system among patients with vascular disorders influences the course of their diseases as well as the results of operations and postoperative follow-up. While the activation ot thrombin cannot be measured directly, because it connects with antithrombin forming the complex, Therefore, the assesment of thrombin - antithrombin (TAT) complex levels in the blood serum of that patients seems to be the reasonable method to estimate their susceptibility to postoperative complications. Methods: 60 patients were included in the study: 20 with AAA and 40 with PAD. Among patients with PAD: 20 were treated with PTA for the first time and 20 were treated with PTA due to the restenosis after PTA pefrformed beforehand. 20 healthy volunteers were the control group. All the patients (and volunteers) had the sample of the blood collected in admission to the hospital and the level of the TAT coplex were measured. Results: The mean levels of the TAT complexes in the blood serum among patients with AAA were 10,6g/l. Therefore they were elevated more than twice above the norm (4,1g/l). Patients with PAD admitted for the first-time PTA had the mean level of TAT complexes sligtly elevated (mean4,8g/l), but patients with PAD admitted to treat the postoperative complications (restenosis after PTA) had the levels of TAT complexes even higher than patients with AAA (mean 11,8g/l). The levels of the TAT complexes among healthy volunteers did't exceed the norm (max.4g/l). Conclusion: The measurment of the levels of the TAT complexes in the blood serum among the patients with vascular disorders seem to be the good method of assessment of the severity of their disease as well as their susceptibility to complications. The correlation between the thrombin - antithrombin complex levels and patients' susceptibility to complications after the endovascular interventions (which is the subject of our ongoing study) should reveal the predictive value of this method in the nearest future. Disclosure: Nothing to disclose

Distribution and predictive accuracy of the Index of Caring Complexity in a semi-intensive care unit

To analyze nursing complexity level and its relationship with mortality and length of stay. Observational study carried out between 1/06/2014 to 21/06/2015 at High Dependency Unit of an Italian University Hospital. The nursing needs and the Index of Caring Complexity (Indice di Complessità Assistenziale, ICA) were collected following the "Modello delle Prestazioni Infermieristiche". Data from 506 patients were collected for a maximum of 4 days of hospital stay (1,436 data collection). Nursing needs with the higher score were mostly related to cardio-circulatory function. Average ICA was 38.4. Only 17.2% of patients were classified as "high complexity" at admission. During the hospital stay, the ICA showed a progressive decrease in survivors while increased in those who died. Overall, the ICA showed high predictive accuracy regarding the risk of death (90.3%; p=0.006); the best ICA cut-off point was 41.5. The risk of death increased with the increasing complexity of nursing care. Exceeding the ICA cut-off value, as well as an increasing trend in the ICA daily monitoring, may be adopted as criteria to identify patients at higher risk, for which increasing, for example, the nurse-patients ratio. Identification of the patient's complexity level may enable the delivery of more personalized nursing activities or interventions based on the intensity of care needed, as well as the proper allocation of patients during hospitalization. This strategy may allow the rationalization of available resources and better planning and implementation of nursing care.

Assessment of Clinical Pharmacy Interventions in the Intensive Care Unit

Clinical pharmacy services have been shown to reduce adverse drug events and health care costs. However, few studies have assessed their effect on patient outcomes in the intensive care unit (ICU). To describe characteristics of ICU patients with documented pharmacist interventions and to evaluate the relationships between patients' complexity level and pharmacists' interventions and between pharmacists' interventions and mortality rate. Inpatient records of admissions between January 1, 2004, and March 31, 2007, were analyzed to identify the presence of clinical pharmacy notes (CPNs). The characteristics of patients with and without CPNs were compared using descriptive statistics. For primary analysis of the association between patient complexity level and presence of CPNs, logistic regression modelling was performed to adjust for potential confounding. Logistic regression was also used to explore the possible association between CPNs and mortality. Finally, mortality analysis was carried out for patients with and without CPNs, with matching by complexity level. The main study cohort comprised 1561 patients: 333 (21.3%) with CPNs and 1228 (78.7%) with no CPNs. A greater proportion of those with a CPN had the highest complexity level: 295 (88.6%) of those with CPNs versus 660 (53.7%) of those with no CPNs. After adjustment for age and sex, the odds ratio for having a CPN among patients with complexity level 4 (relative to patients with lower complexity levels) was 8.20 (95% confidence interval 5.44-12.38). Mortality rates were not significantly different between the 2 groups: 26.7% (89/333) among patients with CPNs and 27.9% (343/1228) among those without CPNs (p = 0.66). After adjustment for age, sex, complexity level, and length of stay in the ICU, the presence of a CPN was not significantly associated with mortality. Mortality rates in the matched cohort (n = 1078) were also similar between patients with and without CPNs (89/333 [26.7%] and 226/745 [30.3%], respectively; p = 0.23), and the presence of a CPN was not significantly associated with mortality after adjustments for potential confounding factors. Documenting clinical pharmacy activities is essential for assessing pharmacists' impact on patient outcomes. These data suggest that ICU pharmacists prioritize clinical activities to care for the sickest patients.

Randomized controlled trial of feedback on cost of hospital care among gastroenterology inpatients

Spending on hospital inpatients comprises a major proportion of healthcare costs. This study assessed the impact of systematic feedback to gastroenterologists on the cost of care provided to inpatients on a gastrointestinal/hepatology (GIH) hospital service. Patients with a GIH diagnosis were randomly assigned to be cared for by one of two hospital services. Over 3 months, teams were randomized to receive feedback (GIH A) or no feedback (GIH B, control group); feedback consisted of an email sent twice weekly to all physicians on the GIH A service detailing the length of stay (LOS) and real-time cost of care accrued by each inpatient. Over 3 months, care was provided to 56 (GIH A) and 47 (GIH B) inpatients with a GIH illness. Patient complexity level was similar for both services as demonstrated by mean relative value: 1.11 (GIH A) vs. 1.27 (GIH B), p=0.2. Weighted LOS and weighted cost of care values were calculated to adjust for the respective RV of each patient. Mean weighted LOS (10.8 [GIH A] vs. 13.8 days/pt [GIH B], p=0.02) and mean weighted cost of care (9,904 [GIH A] vs. 12,654 euros/pt [GIH B], p=0.02) were significantly lower in the feedback group. Subsequent hospital readmission rates did not differ among both groups. Systematic feedback on cost of care was associated with lower healthcare costs without compromising quality. Incorporating a running total of patient costs into computer software used to order patient tests may represent one approach to controlling healthcare expenses.

ADAMTS13 Antigen, Activity, and Autoantibody and ADAMTS13/fXI Complex Levels in Patients with Venous Thromboembolism.

ADAMTS13 controls thrombus formation in microvasculature by proteolysis of ultralarge von Willebrand Factor in plasma. Severe ADAMTS13 dysfunction or deficiency due to genetic or immunological causes can result in the life-threatening microangiopathic disorder Thrombotic Thrombocytopenic Purpura (TTP). Although it may also be involved in limiting thrombus growth in larger vessels, the role of ADAMTS13 in other thrombotic disorders has not yet been clearly established. In this study we determined the levels of ADAMTS13 antigen, activity, autoantibody, and ADAMTS13/fXI complex in plasma from patients with venous thromboembolism (VTE) and from normal donors. ADAMTS13 antigen was measured using IMUBIND® ADAMTS13 Antigen ELISA, ADAMTS13 activity using the ACTIFLUOR™ ADAMTS13 Activity (FRET-based assay), ADAMTS13 autoantibody titers using IMUBIND® ADAMTS13 Autoantibody ELISA, and complex using IMUBIND® ADAMTS13/fXI Complex ELISA. The various ADAMTS13 related markers were all found to be abnormal in patients with VTE (deep vein thrombosis and pulmonary embolism) as compared with normal donors. For normal donors, the mean ADAMTS13 activity is 740 ± 110 ng/ml, whereas in patients with VTE ADAMTS13 activity is significantly lower (524 ± 200 ng/ml, P<0.001). ADAMTS13 antigen levels, however, do not differ significantly for patients with VTE compared with normal donors. Receiver-operating characteristic analysis of activity/antigen ratios shows high sensitivity and specificity for patients with VTE. Although the biochemistry and in vivo biology of the ADAMTS13/fXI complex is not completely understood, the ADAMTS13/fXI complex is 3.8-fold higher in patients with VTE relative to normal donors (P<0.05). Using an upper autoantibody cutoff level of 14.8 AU/ml, a higher percentage of patients with VTE have elevated levels of autoantibodies (26/94 or ∼28%) compared with normal donors (1/47 or ∼2%). D-dimer plasma level is a strong negative predictor for VTE. A substantial number of patients without VTE exhibit D-dimer levels above the normal cutoff, which thus excludes this assay for the positive diagnosis of VTE. We correlated D-dimer levels with the various ADAMTS13 parameters. Elevated D-dimer in patients correlates with abnormal levels of activity, autoantibody, and complex. Donors with high D-dimer levels that do not exhibit symptoms of VTE do not have abnormal activity or complex levels, but do have elevated autoantibody levels. These data suggest that ADAMTS13 activity, autoantibody, and ADAMTS13/fXI complex are potential biomarkers for VTE and furthermore, suggest that ADAMTS13 may play a role in the initiation or progression of VTE.

Prolactin and IgG-prolactin complex levels in patients with rheumatic arthritis.

Prolactin and IgG-prolactin complex levels in patients with rheumatic arthritis.

The Relationship of Various Factors in the Pathogenesis of Atherosclerosis

In this study we investigated the levels of lipid parameters, fibronectin, tissue-type plasminogen activator and plasminogen activator inhibitor (t-PA-PAI-1) complex and si alidase in patients with coronary heart disease and a control group. Total cholesterol, triglyceride, low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) cholesterol and lipoprotein Lp(a), levels in patients with coronary heart disease were found to be significantly higher than in the control group (p &lt; .001). High-density lipoprotein (HDL) cholesterol levels in patient group were significantly lower than control group (p &lt; .001). Plasma fibronectin and t-PA-PAI-1 complex levels in patients with coronary heart disease were found to be significantly higher than control group (p &lt; .05 and p &lt; .001, respectively). In addition, we found that serum sialidase levels in patients with coronary heart disease were significantly higher than in the control group (p &lt; .001). The electrophoretic mobility of lipoproteins from patients with coronary heart dis ease was found to be greater than those from the control group. As a result Lp(a) may play an important role in the pathogen esis of atherosclerosis by causing foam cell formation because of interacting with LDL or fibronectin and by interfering with the fibrinolytic system because of binding to plasminogen re ceptors. In addition, modifications of Lp(a) (including desi alylation) may effect these events. Key words: Coronary heart disease—tPA-PAI-1 complex-Fibronectin-sialidase-Lipid parameters.

PLASMA Lp(a) AND t-PA-PAI-1 COMPLEX LEVELS IN CORONARY HEART DISEASE

In this study we investigated serum Lp(a) and plasma t-PA-PAI-1 complex levels in patients with coronary heart disease (CHD). Serum total cholesterol, triglyceride, LDL and VDL cholesterol levels (p < 0.001) and HDL cholesterol levels (p < 0.01) in patients group were found to be significantly different from those in control group. The mean Lp(a) and t-PA-PAI-1 complex levels in patients with coronary heart disease were significantly higher as compared to control group (p < 0.001). This data indicate that the elevated levels of serum Lp(a) and plasma t-PA-PAI-1 complex may play an important role in the pathogenesis of coronary atherosclerosis.

Prothrombin fragment 1+2 and thrombin-antithrombin complex levels in patients with inherited APC resistance due to factor V Leiden mutation.

Inherited activated protein C (APC) resistance is a newly described pathological condition associated with familial thrombophilia. A recent report on family with APC resistance showed increased levels of prothrombin fragment 1 + 2 (F1 + 2) in the affected individuals. No data concerning thrombin-antithrombin complex (TAT) levels in patients with inherited APC resistance are presently available. The aim of this study was to assess the plasma levels of F1 + 2 and TAT in patients with inherited APC resistance due to factor V (F.V) Leiden mutation and to evaluate F1 + 2 and TAT levels in symptomatic and asymptomatic patients with the defect ('carriers') as compared to their family members having no evidence of F.V Leiden mutation ('non-carriers'). One hundred and twenty-nine individuals belonging to 30 families with inherited APC resistance due to F.V Leiden mutation were studied. F1 + 2 and TAT levels were determined using two commercially available ELISA kits and cut-off values were defined as the higher limits of normal ranges obtained in healthy volunteers. Out of the 129 family members investigated, 36 were non-carriers, 85 were heterozygous and eight homozygous for F.V Leiden mutation. Thrombosis had occurred in 2/36 (6%) non-carriers, in 36/85 (42.3%) heterozygous and in 5/8 (63%) homozygous. Median levels of F1 + 2 and TAT were above cutoff values in carriers, whereas they were below in non-carriers. An overall percentage of 68.8% of carriers exhibited F1 +2 levels above the cut-off value as compared to 38.9% of non-carriers. For TAT, an overall percentage of 63.4% of carriers presented with levels above the cut-off compared with 28% of non-carriers. In conclusion, patients with inherited F.V Leiden mutation may exhibit increased levels of F1 + 2 and TAT. There are no differences in F1 + 2 and TAT median levels among symptomatic and asymptomatic carriers. The percentage of carriers of F.V Leiden with levels of F1 + 2 and TAT above cut-off appears to be higher than that found in other clotting inhibitors defects and in this respect the defect might be considered different. However, these findings and the presence of high percentage of non-carriers presenting with increased F1 + 2 and TAT levels may suggest the possible coexistence in these families of other unknown defects predisposing to thrombosis.

Elevation of Plasma Truncated Elastase α1-Proteinase Inhibitor Complexes in Patients with Inflammatory Lung Diseases

Human neutrophil elastase plays an important role in the development of several inflammatory lung diseases; however, there have been relatively few investigations using plasma samples. In this report, we describe alterations in the plasma elastase:alpha 1-PI complex in patients with chronic obstructive pulmonary disease (COPD) (15 cases), COPD with infection (8), diffuse panbronchiolitis (DPB) (8), bronchiectasis (9), pneumonia (10), and the adult respiratory distress syndrome (ARDS) (14), and in 15 normal volunteers. The elastase:alpha 1-PI complex concentration was determined by an enzyme-linked immunosorbent assay. Western immunoblot analysis of the elastase:alpha 1-PI complex was also performed. Plasma elastase:alpha 1-PI complex was also performed. Plasma elastase:alpha 1-PI complex levels in patients with COPD with infection (504 micrograms/L +/- 93 micrograms/L) were significantly higher, as compared with those with COPD but without infection (118 micrograms/L +/- 9 micrograms/L) and normal volunteers (122 micrograms/L +/- 4 micrograms/L). Increased complex concentrations were also found in patients with DPB and bronchiectasis (643 micrograms/L +/- 222 micrograms/L and 558 micrograms/L +/- 198 micrograms/L, respectively) as compared with normal volunteers. Increased complex concentrations were also found in patients with pneumonia and ARDS (450 micrograms/L +/- 101 micrograms/L and 1,400 micrograms/L +/- 438 micrograms/L, respectively). Western immunoblot analysis using anti-alpha 1-PI antibody and antineutrophil elastase antibody showed two types of elastase:alpha 1-PI complexes, one with a molecular weight of 60,000 daltons (60 kilodaltons [KD]) and the other at 50,000 daltons (50 KD). Although the native 80-KD elastase:alpha 1-PI complex was detected in bronchoalveolar lavage fluid, it was not found in plasma. In summary, these results demonstrated that levels of the truncated complex were increased in patients with various inflammatory lung diseases. This truncated form may play an important role in the pathophysiology of inflammatory processes.

The transient increase of plasma thrombin-antithrombin III (TAT) complex levels in patients with congenital antithrombin III deficiency during antithrombin III administration is due to extraction of thrombin from fibrin

The transient increase of plasma thrombin-antithrombin III (TAT) complex levels in patients with congenital antithrombin III deficiency during antithrombin III administration is due to extraction of thrombin from fibrin

Circulating immune complex levels in patients with schistosomiasis and complications

Circulating immune complexes (CIC), adult schistosome antibody, and total immunoglobulin concentrations were estimated in sera from 35 chronic Schistosoma mansoni patients with different infection intensities and different pathological complications. High CIC levels were present in about one-third ( 10 35 ) of the sera. Most of the patients ( 9 10 ) with elevated CIC levels also had hepatomegaly or hepatosplenomegaly. This finding is significant in the pathogenesis of schistosomal iver fibrosis and may also apply to other liver diseases, especially cirrhosis. No correlation was found between infection intensity as judged by stool egg counts and CIC levels. A reverse relationship was observed between the level of anti-adult worm IgG and CIC levels. CIC levels were elevated within 7 and 28 days after treatment in most patients. Hypergammaglobulinaemia was detected in most sera.

Circulating immune complexes in rheumatic fever.

We measured the circulating immune complex levels in patients with rheumatic fever using the following three methods: the C1q binding test, the conglutinin binding test and Raji cell radioimmunoassay. Thirty-four samples from 21 patients with rheumatic fever were examined, and circulating immune complexes were detected in 47.6% of the patients by one or more of these methods. Especially by the C1q binding test, the sera obtained in the acute phase were found to contain the circulating immune complexes with higher frequency than those obtained in the post-acute phase. Therefore, the C1q binding test was more likely to be useful in the acute phase of this disease. The present study suggests that the circulating immune complexes are related to the pathogenesis of rheumatic fever.

Use of circulating immune complex levels in the serodifferentiation of endocarditic and nonendocarditic septicemias

Distinguishing endocarditic from nonendocarditic septicemias is prognostically and therapeutically important. One hundred two patients with both valvular and nonvalvular sepsis were studied for the presence and quantitation of circulating immune complexes. Ninety per cent of the patients with infective endocarditis versus 50 per cent of septic patients without infective endocarditis had circulating immune complex levels (p < 0.005). Mean circulating immune complex levels in patients with infective endocarditis were significantly higher than in those without infective endocarditis, 106 ± 18.58 μg/ml versus 31 ± 7.4 μg/ml (p < 0.005). Only three of 52 patients without infective endocarditis had circulating immune complex levels > 100 μg/ml, as opposed to 16 of 50 patients with infective endocarditis (p < 0.005). Similarly, one of 52 patients without infective endocarditis has circulating immune complex levels > 200 μg/ml, as opposed to eight of 50 patients with infective endocarditis (p < 0.05). In 92 per cent of thepatients without infective endocarditis and 76 per cent of those with infective endocarditis peak circulating immune complex levels developed within 14 days after their entry into the study, often on the initial sampling. In febrile, septicemic patients with clinical syndromes nonclassic for endocarditis, measurements of serial circulating immune complex levels may be of adjunctive diagnostic importance. If circulating immune complex levels are undetectable, endocarditis would appear less likely; alternatively, levels above 100 to 200 μg/ml would suggest a valvular rather than nonvalvular septic focus.