Decreased Serum Albumin Research Articles

Effects of secnidazole-diminazene aceturate combination therapy on parasitaemia and serum biochemical profile after late treatment in Trypanosoma brucei brucei infected dogs

Relapse parasitaemia is a major setback in the chemotherapy of a late stage Trypanosoma brucei brucei infection. An aberrant serum biochemical profile resulting from a T. b. brucei infection in dogs has been attributed to multiple organ injuries resulting from the invasive nature of the organism. Therapy with diminazene aceturate alone has not been satisfactory. This study evaluated the effects of a secnidazole-diminazine aceturate (SEC-DA) combination therapy on parasitaemia and the serum biochemical profile after the late treatment of a T. b. brucei infection in dogs. Eighteen dogs were randomly assigned to 6 groups (n = 3) as follows: Group A: uninfected nor treated; group B: infected without treatment; group C: infected and treated with DA (3.5 mg/kg) (DA-monotherapy) intramuscularly (i.m.) once; group D: infected and treated with SEC (100 mg/kg) and DA (3.5 mg/kg); group E: in-fected and treated with SEC (200 mg/kg) and DA (3.5 mg/kg) and group F: infected and treated with SEC (400 mg/kg) and DA (3.5 mg/kg). Secnidazole was administered orally for 5 days while DA was given i.m. once in groups D–F. The dogs were infected with 5 × 10<sup>5</sup> trypanosomes intraperitoneally and treatment started 14 days post-infection. The parasitaemia was monitored daily while the serum biochemical indicators were monitored 14, 21, and 28 days post-infection. The total aparasitaemia was achieved in the SEC-DA treated dogs 72 h post-treatment and in 86 h in the DA-monotherapy dogs. A relapse parasitaemia occurred in the DA-monotherapy dogs 17 days post-treatment. The SEC-DA combination therapy caused a significant (P < 0.05) decline in the hitherto elevated urea and creatinine concentrations, and the ALP, ALT, AST activities. Also, there was a significant (P < 0.05) increase in the previously decreased serum albumin in the SEC-DA treated dogs. In conclusion, secnidazole-diminazene aceturate combination therapy prevented the relapse parasitaemia and ameliorated aberrant serum biochemical profiles of T. b. brucei infected dogs after late treatment.

Time to Relapse and Its Predictors among Children with Nephrotic Syndrome in Comprehensive Specialized Hospitals, Tigray, Ethiopia, 2019.

Background Relapse in children with nephrotic syndrome leads to a variety of complications due to prolonged treatment and potential dependency on steroids. However, there is no study conducted to determine the incidence and predictive factors of relapse for nephrotic syndrome in Ethiopia, especially in children. Thus, this study aimed to assess the incidence of relapse and its predictors among children with nephrotic syndrome in Ethiopia. Methods A retrospective study was conducted by reviewing all charts of children with an initial diagnosis of the nephrotic syndrome in tertiary hospitals from 2011 to 2018. Charts of children with a diagnosis of steroid-resistant cases were excluded. The extraction tool was used for data collection, Epi-data manager V-4.4.2 for data entry, and Stata V-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, life table, and crude hazard ratios were used to describe the data and adjusted hazard ratios with 95% CI and P value for analysis. Median relapse time, incidence rate of relapse, and cumulative relapse probabilities at a certain time interval were computed. Bivariable and multivariate analyses were performed using the Cox proportional hazard regression to identify the factors associated with relapse. Any variable at P < 0.25 in the bivariable analysis was transferred to multivariate analysis. Then, the adjusted hazard ratio with 95% CI and P ≤ 0.05 was used to report the association and to test the statistical significance, respectively. Finally, texts, tables, and graphs were used to present the results. Results and Conclusion. Majority, 64.5% (40/66), of relapses were recorded in the first 12 months of follow-up. The incidence rate of relapse was 42.6 per 1000 child-month-observations with an overall 1454 child-month-observations and the median relapse time of 16 months. Having undernutrition [AHR = 3.44; 95% CI 1.78-6.65], elevated triglyceride [AHR = 3.37; 95% CI 1.04-10.90], decreased serum albumin level [AHR = 3.51; 95% CI 1.81-6.80], and rural residence [AHR = 4.00; 95% CI 1.49-10.76] increased the hazard of relapse. Conclusion and Recommendation. Relapse was higher in the first year of the follow-up period. Undernutrition, hypoalbuminemia, hypertriglyceridemia, and being from rural areas were independent predictors of relapse. A focused evaluation of those predictors during the initial diagnosis of the disease is compulsory.

Hepatobiliary phase of gadoxetic acid-enhanced MRI in patients with HCC: prognostic features before resection, ablation, or TACE.

Patients with hepatocellular carcinoma (HCC) receiving different treatments might have specific prognostic factors that can be captured in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI). We aimed to identify the clinical findings and HBP features with prognostic value in patients with HCC. In this retrospective, single-institution study, we included patients with Barcelona Clinic Liver Cancer very early/early stage HCC who underwent GA-MRI before treatment. After performing propensity score matching, 183 patients received the following treatments: resection, radiofrequency ablation (RFA), and transarterial chemoembolization (TACE) (n = 61 for each). Cox regression models were used to identify clinical factors and HBP features associated with disease-free survival (DFS) and overall survival (OS). In the resection group, large tumor size was associated with poor DFS (hazard ratio [HR] 4.159 per centimeter; 95% confidence interval [CI], 1.669-10.365) and poor OS (HR 8.498 per centimeter; 95% CI, 1.072-67.338). In the RFA group, satellite nodules on HBP images were associated with poor DFS (HR 5.037; 95% CI, 1.061-23.903) and poor OS (HR 9.398; 95% CI, 1.480-59.668). Peritumoral hypointensity on HBP images was also associated with poor OS (HR 13.062; 95% CI, 1.627-104.840). In addition, serum albumin levels and the prothrombin time-international normalized ratio were associated with DFS and/or OS. Finally, in the TACE group, no variables were associated with DFS/OS. Different HBP features and clinical factors were associated with DFS/OS among patients with HCC receiving different treatments. • In patients who underwent resection for HCC, a large tumor size on HBP images was associated with poor disease-free survival and overall survival. • In the RFA group, satellite nodules and peritumoral hypointensity on HBP images, along with decreased serum albumin levels and PT-INR, were associated with poor disease-free survival and/or overall survival. • In the TACE group, no clinical or HBP imaging features were associated with disease-free survival or overall survival.

Metabolic and Nutritional Characteristics in Middle-Aged and Elderly Sarcopenia Patients with Type 2 Diabetes.

Sarcopenia is considered to be a new complication of type 2 diabetes (T2DM) leading to increased risk of adverse outcome. We performed a survey to evaluate glucose metabolism and nutritional status in sarcopenia patients with T2DM. Diabetic participants aged ≥50 years were grouped into a probable sarcopenia group with low muscle strength (n = 405) and a nonsarcopenia group with normal muscle strength (n = 720) according to the revised recommendations from EWGSOP2 (2018). Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, longer diabetes duration, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate and lower bone mineral content, lower fatless upper arm circumference, lower appendicular skeletal muscle mass index (ASMI), and muscle quality in both genders. Multivariable logistic regression analysis showed increased age, male, low BMI, and increased HbA1c, combined with diabetic nephropathy and decreased serum albumin levels, were risk factors associated with low muscle strength in diabetes patients. In conclusion, diabetic patients with sarcopenia had worse glucose metabolism and nutritional status, decreased renal function and reduced muscle quality ,and muscle mass with a greater likelihood of osteoporosis, who need an overall health management to improve outcomes. This clinical trial registration is registered with the Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Pre-, Intra-, and Posttreatment Serum Albumin Predicts for Clinical Radiation Pneumonitis in Locally Advanced Non-Small Cell Lung Cancer Patients Treated with Radiochemotherapy

Limited data exists on pretreatment immune parameters such as neutrophil-to-lymphocyte ratios (NLR) in patients receiving radiotherapy, especially during or after treatment. We sought to correlate pretreatment (pre-RT – within 90d), intratreatment (intra-RT), and posttreatment (post-RT – within 90 d) NLRs and albumin levels to radiation pneumonitis (RP) and overall survival (OS) of locally advanced lung cancer patients treated with definitive chemoradiotherapy. Hematologic values of 125 patients with locally advanced lung cancer treated between 2009-2018 were collected. Given the retrospective nature, the following were the sample sizes for each parameter: pre-RT/intra-RT/post-RT NLRs n = 80/76/39, respectively; pre-RT/intra-RT/post-RT albumin n = 82/52/73, respectively. NLRs and differences between pre-RT and intra-RT NLRs (delta-NLR) were calculated. RP was recorded as RTOG grade ≥3 RP requiring steroid medication. Kaplan-Meier statistics, univariate Cox regressions (UVA), and logistic models were used. The median age of the cohort was 58.9 years (54.1-65.2) with median follow up of 1.96 years (0.05-10.61) after RT. The majority of patients were stage IIIA/IIIB (80%) with median lung V20Gy of 28% (21-30). Median pre-RT/intra-RT/post-RT NLR was 2.92 (0.5-17), 12.13 (1.8-43), and 5.6 (0.91-40), respectively. 64 (95.2%) patients had increasing NLR during treatment, with the absolute median increase of 8.4 (3.1-15.22), a median 2.6x increase (0.7-4.9). The absolute median increase between post-RT and pre-RT NLRs was +2.2 (+0.4-5.2), a median 1.8x increase (1.2-2.4) with 80.6% (25/31) of patients experiencing a higher post-RT NLR. Median pre-RT/intra-RT/post-RT albumin was 4.2 g/dL (3.2-4.9), 3.98 g/dL (2.74-4.70), and 3.85 g/dL (2.46-4.62), respectively. 59.5% (22/37) and 75.5% (40/53) had a decrease of their albumin levels from pre-to-intra-RT and pre-to-post-RT, respectively, by a median -0.18 (-0.4 to 0.11) and -0.29 (-0.6 to 0), respectively. Five-year OS for the entire cohort was 33.3%. Higher intra-RT and post-RT albumin levels were correlated with improved OS (HR 0.36, p = 0.001 and 0.03, respectively), however pre-RT/intra-RT/post-RT NLR were not (p = 0.36/0.34/0.15 respectively). 5-year OS stratified by median post-RT albumin level (3.85) was 49.8% vs. 19.6% (p = 0.01). Twenty patients (16%) experienced RP. There was a trend towards higher pre-RT NLR predicting development of RP (p = 0.057). Decrease in albumin level from pre- to post-RT predicted for RP (p = 0.04). The majority of patients experienced an increased neutrophil-predominant inflammatory response and a decreased serum albumin level during chemoradiotherapy. Contrary to the current literature, higher NLRs did not predict for poorer OS, but higher albumin level during and after radiotherapy was correlated with improved OS. Higher pre-RT NLR and decrease in albumin level during radiation were correlated with clinical grade 3+ RP, and should be explored further.

Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury: A Retrospective Cohort Study.

Community-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development among patients with CAPIs because most studies exclude patients with CAPIs. The purpose of our study was to determine the incidence of HAPI development and the associated risk factors among surgical critical care patients with CAPIs. Retrospective cohort study. We used electronic health record data from adult critical care patients admitted to the surgical and cardiovascular surgical intensive care units (ICUs) at a level 1 trauma center and academic medical center between 2014 and 2018. Univariate analysis was used to compare patients with CAPIs who developed a HAPI and those who did not, as well as logistic regression analysis to identify independent risk factors for HAPIs among patients with CAPIs. Among 5101 patients admitted to 2 surgical critical care units, 167 (3%) patients were admitted with CAPIs. Hospital-acquired pressure injuries were 4 times more common among patients with CAPIs compared to patients without CAPIs. Among the 167 patients with CAPIs, 47 patients (28%) went on to also develop a HAPI, whereas in the 4934 patients without CAPIs, 352 patients (7%) went on to develop a HAPI. Findings from the multivariate logistic regression analysis (n = 151) showed that decreased serum albumin (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.25-0.85; P = .02) and excessively dry skin (OR = 2.6; 95% CI, 1.1-6.22; P = .03) were independent predictors of HAPI development among patients admitted with CAPIs. Results from our study show that patients with CAPIs are at high risk for developing a HAPI, particularly among patients with decreased serum albumin or excessively dry skin. Patients with excessively dry skin may benefit from the application of skin moisturizers.

Prevalence of chronic kidney disease in Brazilians with arterial hypertension and/or diabetes mellitus.

The present study aimed to evaluate the prevalence of chronic kidney disease (CKD) in individuals with arterial hypertension (AH) and/or diabetes mellitus (DM) accompanied by Primary Health Care (PHC) in Brazil. The estimated glomerular filtration rate (eGFR) based on creatinine, and urinary albumin-to-creatinine ratio (ACR) were measured in 841 subjects with AH and/or DM, followed by PHC in the city of Viçosa. The CKD was diagnosed according to KDIGO criteria. Sociodemographic, clinical, and anthropometric factors related to the prevalence of CKD were investigated through multiple logistic regression. The prevalence of hidden CKD was 15.4%. Of these, 7.5% were identified by albuminuria (ACR ≥30mg/g) with slightly decreased eGFR. Age, baseline disease, waist circumference (WC), and systolic blood pressure remained associated with CKD after multivariate analysis. The two major risk factors for hidden CKD were the presence of AH in association with DM and an increase in age. Hidden CKD was more common within people with AH and DM, and with high WC, glycosylated hemoglobin, and serum phosphorus as well as male gender and decreased serum albumin. This knowledge of risk associations can help avoid progression to CKD.

Association Between Serum Albumin Level and All-Cause Mortality in Patients With Chronic Kidney Disease: A Retrospective Cohort Study

BackgroundThe association between serum albumin and all-cause mortality (ACM) in patients with chronic kidney disease (CKD) is presently unclear. MethodsThe study subjects included 201 patients diagnosed with CKD, eliminating those with end-stage renal disease, who were admitted to our hospital from January 2014 to January 2015. The patients were divided into 4 groups according to serum albumin level (Q1: 1.60–3.88 g/dL; Q2: 3.89–4.13 g/dL; Q3: 4.14–4.43 g/dL, and Q4: 4.44–5.51 g/dL). The clinical outcome was ACM, and the difference was compared using odds ratio (OR) and 95% confidence interval (CI). ResultsAfter a median follow-up of 1480 days, 32 patients died (15.92%). The ACM was found to be 28.00%, 20.00%, 8.00%, and 7.84% in the 4 groups (P = 0.012). Pearson correlation analysis revealed a positive association between the serum albumin level and glomerular filtration rate (GFR) (r = 0.22, P = 0.001). Once the potential confounding factors were adjusted, the results indicated that decreased serum albumin was a risk factor for ACM (Q2 vs Q1: OR = 0.50, 95% CI: 0.17–1.47; Q3 vs Q1: OR = 0.12, 95% CI: 0.03–0.48; Q4 vs Q1: OR = 0.26, 95% CI: 0.07–0.98). The receiver operating characteristic curve indicated that the optimum threshold of serum albumin to predict ACM was 4 g/dL, and the area under the curve was 0.69 (95% CI: 0.60–0.79). ConclusionsDecreased serum albumin is a risk factor for ACM in patients with CKD, with the optimal threshold being 4 g/dL.

Repeated Administration of Clinical Doses of Tramadol and Tapentadol Causes Hepato- and Nephrotoxic Effects in Wistar Rats

Tramadol and tapentadol are fully synthetic and extensively used analgesic opioids, presenting enhanced therapeutic and safety profiles as compared with their peers. However, reports of adverse reactions, intoxications and fatalities have been increasing. Information regarding the molecular, biochemical, and histological alterations underlying their toxicological potential is missing, particularly for tapentadol, owing to its more recent market authorization. Considering the paramount importance of liver and kidney for the metabolism and excretion of both opioids, these organs are especially susceptible to toxicological damage. In the present study, we aimed to characterize the putative hepatic and renal deleterious effects of repeated exposure to therapeutic doses of tramadol and tapentadol, using an in vivo animal model. Male Wistar rats were randomly divided into six experimental groups, composed of six animals each, which received daily single intraperitoneal injections of 10, 25 or 50 mg/kg tramadol or tapentadol (a low, standard analgesic dose, an intermediate dose and the maximum recommended daily dose, respectively). An additional control group was injected with normal saline. Following 14 consecutive days of administration, serum, urine and liver and kidney tissue samples were processed for biochemical, metabolic and histological analysis. Repeated administration of therapeutic doses of both opioids led to: (i) increased lipid and protein oxidation in liver and kidney, as well as to decreased total liver antioxidant capacity; (ii) decreased serum albumin, urea, butyrylcholinesterase and complement C3 and C4 levels, denoting liver synthesis impairment; (iii) elevated serum activity of liver enzymes, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and γ-glutamyl transpeptidase, as well as lipid profile alterations, also reflecting hepatobiliary commitment; (iv) derangement of iron metabolism, as shown through increases in serum iron, ferritin, haptoglobin and heme oxygenase-1 levels. In turn, elevated serum cystatin C, decreased urine creatinine output and increased urine microalbumin levels were detected upon exposure to tapentadol only, while increased serum amylase and urine N-acetyl-β-D-glucosaminidase activities were observed for both opioids. Collectively, these results are compatible with kidney injury. Changes were also found in the expression levels of liver- and kidney-specific toxicity biomarker genes, upon exposure to tramadol and tapentadol, correlating well with alterations in lipid profile, iron metabolism and glomerular and tubular function. Histopathological analysis evidenced sinusoidal dilatation, microsteatosis, mononuclear cell infiltrates, glomerular and tubular disorganization, and increased Bowman’s spaces. Although some findings are more pronounced upon tapentadol exposure, our study shows that, when compared with acute exposure, prolonged administration of both opioids smooths the differences between their toxicological effects, and that these occur at lower doses within the therapeutic range.

Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases.

Coronavirus disease 2019 (COVID-19) is a global pandemic which has caused numerous deaths worldwide. The present study investigated the roles of hypoproteinemia in the clinical outcome and liver dysfunction of COVID-19 patients. In this retrospective study, we extracted data from 2,623 clinically confirmed adult COVID-19 patients (>18 years old) between January 29, 2020 and March 6, 2020 in Tongji Hospital, Wuhan, China. The patients were divided into three groups—non-critically ill, critically ill, and death groups—in accordance with the Chinese Clinical Guideline for COVID-19. Serum albumin, low-density lipoproteins cholesterol (LDL-C), and high-density lipoproteins cholesterol (HDL-C) concentrations and inflammatory cytokines levels were measured and compared among these three groups. The median age of these 2,623 patients was 64 years old (interquartile range (IQR), 52–71). Among the patients enrolled in the study, 2,008 (76.6%) were diagnosed as non-critically ill and 615 (23.4%) were critically ill patients, including 383 (14.6%) critically ill survivors and 232 (8.8%) critically ill deaths in the hospital. Marked hypoalbuminemia occurred in 38.2%, 71.2%, and 82.4% patients in non-critically ill, critically ill, and death groups, respectively, on admission and 45.9%, 77.7%, and 95.6% of these three groups, respectively, during hospitalization. We also discovered that serum low-density lipoprotein (LDL) and HDL levels were significantly lower in critically ill and death groups compared to non-critically ill group. Meanwhile, the patients displayed dramatically elevated levels of serum inflammatory factors, while a markedly prolonged activated partial thromboplastin time (APTT) in critically ill patients reflected coagulopathy. This study suggests that COVID-19-induced cytokine storm causes hepatotoxicity and subsequently critical hypoalbuminemia, which are associated with exacerbation of disease-associated inflammatory responses and progression of the disease and ultimately leads to death for some critically ill patients.Electronic Supplementary MaterialSupplementary material is available for this article at 10.1007/s11427-020-1733-4 and is accessible for authorized users.

Prognostic factors in elderly patients admitted to the intensive care unit with community-acquired pneumonia

Objective We aimed to determine the clinical, radiological and laboratory findings that may indicate poor prognosis in severe community acquired pneumonia (CAP) requiring intensified care to reduce the risk of death. Methods The medical histories, demographic characteristics and laboratory values of over 65 years old patients admitted to the intensive care unit (ICU) and diagnosed with CAP were recorded. Results Total of 86 patients were included in the study. Among those patients 39 were discharged from the ICU with health but 47 were expired. Diastolic blood pressure was significantly lower in expired patients (p = 0.044). In multivariate analysis, older age (>78 years) (p = 0.004), at admission elevated blood glucose (>108 mg/dL) levels (p = 0.048), decreased serum albumin (<3.5 g/dL) levels (p = 0.043), elevated serum procalcitonin levels (>0.63 μg/L) (p = 0.034) and in blood gas analysis decreased pH (<7.35) (p = 0.042)and increased lactate (>2mmol/L) (p = 0.001) were the significant risk factors for in-ICU mortality. Conclusions At old age, blood glucose and procalcitonin levels increased at the time of admission, serum albumin levels decreased, pH decreased in blood gas analysis and lactate levels increased, and significant mortality determinants in CAP patients over 65 years of age who applied to the intensive care unit.

P0157GENETICALLY DETERMINED HYPOALBUMINEMIA AND THE RISK OF HYPERTENSION: GWAS-BASED INSTRUMENTAL VARIABLE ANALYSIS

Abstract Background and Aims Hypoalbuminemia is a clinical indicator of vascular endothelial dysfunction. However, the genetic association of hypoalbuminemia with hypertension has not yet been clarified. We investigated whether genetic variation(s) associated with decreased serum albumin level is deeply related with increased risk of hypertension. Method Mild hypoalbuminemia was defined as a serum albumin concentration of less than 4.0 g/dL. We performed GWAS-based instrumental variable analysis using the population-based cohort data collected from KoGES. Eligible as cases were all native Koreans without significant medical illness and a total 4326 participants were divided in into control (n = 3157) and hypoalbuminemic (n = 1168) according to their serum albumin level. Results Our GWAS revealed that 71 susceptibility loci were associated with mild hypoalbuminemia and subsequent two-stage least squares estimation analysis showed that both genetic variations at rs2894536 in LOC107986598 gene and rs10972486 in the ATP8B5P gene were related with systolic blood pressure. In subsequent Cox-proportional hazards model, we found that not only low serum albumin (HR = 0.654, 95% CI = 0.521-0.820), but also polymorphisms of rs2894536 (HR = 1.176, 95% CI = 1.015-1.361) and rs10972486 (HR = 1.152, 95% CI = 1.009-1.316) were significant predictor of hypertension. Our two-stage residual inclusion analysis indicated that candidate genetic variation attenuated the association between serum albumin and hypertension, showing hazard ratios of hypoalbuminemia on development of hypertension were 0.762 (0.659-0.882) for rs2894536 and 0.759 (0.656-0.878) for rs10972486. Conclusion These findings support a causal relationship between hypoalbuminemia-associated genetic variation, hypoalbuminemia and development of hypertension.

P1072COMPARISON OF UREMIC TOXINS, INFLAMMATORY MARKERS AND VEGF LEVEL WITH MEDIUM CUT-OFF MEMBRANES AND HIGH-FLUX MEMBRANES IN HEMODIALYSIS: THERANOVA IN SISLI HAMIDIYE ETFAL (THE SHE) STUDY

Abstract Background and Aims Mortality in hemodialysis have not changed since last 30 years which may be caused by inflammation and accumulation of middle and large uremic toxins. Medium cut-off (MCO) membranes are able to perform hemodialysis as effective as hemodiafiltration. Their effect on inflammatory molecules and vascular endothelial growth factor-C (VEGF), an independent factor effective on mortality, are not well known. The aim of the study was to compare intra and inter dialyzer performances of MCO and high-flux dialyzers regarding middle and large uremic toxin, inflammatory marker, VEGF and serum albumin level. Method This is a randomized, prospective, open-label, cross-over study (ClinicalTrials.gov: NCT03836508) approved by local ethic committee. Patients had hemodialysis with either 36 sessions of high-flux dialyzer followed by 36 sessions of medium cut-off dialyzer or vice versa. Pre and postdialysis levels for urea, creatinine, albumin, total protein, free kappa light chain, free lambda light chain, beta-2 microglobulin, myoglobulin levels were determined at first and last sessions of every dialyzer. Postdialysis level of middle and large uremic molecules have been determined by a formula to prevent hemoconcentration effect. Reduction rate for uremic toxins were calculated. Serum level of human VEGF, fibroblast growth factor-23 (FGF-23), interferon gamma (IFN-g), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-17A (IL-17A) levels were determined at first and last session of the each dialyzer. Results Fifty-two patients were enrolled to the study. Median age of patients was 56.40 (43.87-67.39) years. Median dialysis vintage was 4.77 (3.08-10.09) years. Reduction rates and postdialysis levels of free kappa and lambda light chain, myoglobulin, beta-2 microglobulin were lower both at first and last sessions in medium cut-off dialyzers compared to high-flux dialyzers (p&amp;lt;0.05 for all) (Table 1). Last session predialysis free kappa, free lambda, beta-2 microglobulin level was lower than first session predialysis levels in medium cut-off dialyzers (p&amp;lt;0.05 for all) (Table 2). Last session IL-6, IL-10, IL-17, IFN-gamma levels did not differ between dialyzers (p&amp;gt;0.05 for all). Vascular endothelial growth factor levels were 500.91 (363.80-679.15) pg/ml in medium cut-off group and 610.60 (450.63-1021.93) pg/ml in high-flux group (p=0,043). Predialysis serum albumin level at first session for MCO and high-flux groups were 3.88 (3.71-4.04) g/L and 3.75 (3.59-3.95) g/L, respectively (p=0.086) (Figure 1). After 3 months of hemodialysis, it was 3.62 (3.45-3.88) g/L in MCO group and 3.78 (3.58-4.02) g/L in high-flux group (p=0.04). Serum albumin level has decreased from 3.88 (3.71-4.04) g/L to 3.62 (3.45-3.88) g/L in 3 months during hemodialysis with MCO dialyzers (p=0.0001). It did not change significantly in high-flux group in the same time period (p=0.861). Conclusion MCO membranes not only decrease post dialysis levels of free kappa, free lambda, beta-2 microglobulin, myoglobulin but also decrease the third month predialysis levels of free kappa, free lambda, beta-2 microglobulin. They do not let the increase in myoglobulin level as seen in high-flux dialyzers. Even though the IL-6, IL-10, IL-17, IFN-gamma, FGF-23 levels did not differ, VEGF levels were lower in MCO dialyzer. The most important side effect of hemodialysis with MCO membranes is decreased serum albumin level.

1530-P: Metabolic Characteristics in Chinese Sarcopenia Patients with Type 2 Diabetes

Objective: To evaluate glucose metabolism characteristics in middle-aged and elderly sarcopenia patients with type 2 diabetes. Methods: Data were collected from a multicenter, cross-sectional survey study. Eligible patients aged 50 years or older with a previous diagnosis of type 2 diabetes were recruited from the endocrinology department of nine different hospitals in Beijing, China. All participants were grouped into a probable sarcopenia group with low muscle strength and a nonsarcopenia group with normal muscle strength according to the recommendations from EWGSOP2 (2018). Body composition, glucose metabolism, laboratory and nutritional index were compared between two groups. Results: A total of 1125 diabetic participants were included, with 405 in probable sarcopenia group and 720 in nonsarcopenia control group. Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate, and lower bone mineral content, basal metabolic rate, fatless upper arm circumference, appendicular skeletal muscle mass index (ASMI) and muscle quality in both men and women. The prevalence of low muscle mass was obviously elevated in probable sarcopenia group in both sexes (men: 11.0% vs. 25.4%, women: 6.8% vs. 19.1%). Multivariable logistic regression analysis showed that aged, male sex, low BMI, increased HbA1c, diabetic nephropathy and decreased serum albumin level were risk factors associated with low muscle strength in diabetes patients. Conclusions: Sarcopenic diabetic patients were older and had lower BMI, worse nutritional status and glucose metabolism, decreased renal function and reduced muscle quality and mass with a greater likelihood of osteoporosis. Clinically, diabetic aged patients should receive an assessment on muscle strength and muscle quality to optimize their treatment program. Disclosure Q. He: None. L. Guo: None.

Potential application of nanoemulsified garlic oil blend in mitigating the progression of type 2 diabetes-mediated nephropathy in Wistar rats.

The renoprotective potential of nanoemulsified garlic oil blend (GNE) in alleviating the progressive stages of hyperlipidemia-mediated diabetic nephropathy was examined. The study was carried out in high fat-fed, streptozotocin-induced type 2 diabetic Wistar rats for five months. The diabetic rats showed a significant increase of area under the curve in OGTT (p < 0.01) and IPITT (p < 0.01), increased urinary albumin (p < 0.01), urinary microprotein (p < 0.001), total cholesterol (p < 0.01), triglycerides (p < 0.001) and LDL cholesterol (p < 0.001), with decreased serum albumin (p < 0.01), serum protein (p < 0.001) and HDL-cholesterol levels (p < 0.05) than the control rats. The histopathological analysis evidenced mesangial expansion and hypercellularity at the end of the first and third month, and glomerulosclerosis and tubular atrophy at the end of the fifth month in diabetic rats. Moreover, on disease progression, increase in urinary podocalyxin, NGAL and CD36 was observed, and the renal mRNA and protein expression of podocalyxin decreased significantly with a concomitant increase in NGAL and CD36 expression from first till fifth month end. The treatment with GNE (20mg/kg) significantly ameliorated the serum albumin (p < 0.001) and urine albumin (p < 0.01) from the end of the third month with significant attenuation in the lipid profile than GO (20mg/kg) or Ator (8mg/kg). Moreover, GNE reverted the histopathological alterations and attenuated the aberrant mRNA, protein expression and urinary excretion level of renal CD36, podocalyxin and NGAL in diabetic rats from an early stage of disease till the end of the study period. This study demonstrated the enhanced efficacy of GO in nanoemulsified form in mitigating the progression of nephropathy in type 2 diabetic rats.

Elevated Serum Interleukin-18 Level is Correlated with Vascular Access Dysfunction in Patients on Maintenance Haemodialysis

We evaluated the impact of serum interleukin-18 (IL-18) level on short-term vascular access (VA) function in chronic haemodialysis (HD) patients. Samples were collected from 80 clinically stable patients (58.8% were men) with a mean age of 60.9 years (standard deviation 11.7 years) who were undergoing maintenance HD and were followed up for 1 year. Multivariate logistic regression was used to analyse data on demographics, biochemical parameters and serum IL-18 level to predict VA dysfunction events. The cut-off for IL-18 was derived from the highest score obtained on Youden index. Survival data was analysed using Cox proportional hazards regression analysis and Kaplan-Meier method. Patients were classified as having either low IL-18 (<199.3 pg/mL) or high IL-18 (≥199.3 pg/mL). Multivariate logistic regression showed that serum IL-18 level was independently correlated with VA dysfunction events; patients with high IL-18 had a higher risk of VA dysfunction events than those with low IL-18 (odds ratio 9.47, 95% confidence interval 1.75-51.31, P = 0.009). In patients with high IL-18, Kaplan-Meier survival analysis found that incidence of VA dysfunction was significantly higher than patients with low IL-18 (P = 0.047). After adjustment for age, gender, inflammation (C-reactive protein) and calcium-phosphorus metabolism, decreased serum albumin and increased serum IL-18 levels were found to be independent prognostic predictors of VA dysfunction. HD patients with high IL-18 level tend to have worse rates of VA dysfunction. In HD outpatients, IL-18 is an independent risk factor for short-term VA dysfunction.

Prolonged Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in Adult Patients With Intestinal Failure.

Intestinal failure (IF) and its management are associated with an increased likelihood of infectious complications. This study aimed to evaluate the prevalence and potential risk factors for nosocomial infections (NIs) in hospitalized adult patients with IF. In total, 259 eligible patients with IF admitted to a single clinical nutrition center in a tertiary referral hospital from January 1, 2012, to January 1, 2019, were retrospectively identified. NIs were defined according to the 2008 Centers for Disease Control and Prevention criteria. Univariate and multivariate analyses were performed to identify independent risk factors for NIs. The mean age of the study population was 47.0 ± 17.7 years, and 158 (61.0%) were men. The mean body mass index was 16.2 ± 2.9 kg/m2 , and 219 (84.6%) were diagnosed with malnutrition. The prevalence of NIs was 25.5% (113 NIs in 66 patients). The most common NIs were pneumonia (14.3%), bacteremia of unknown origin (13.5%), catheter-related bloodstream infection (5.0%), lower respiratory tract infection (5.0%), surgical site infection (3.9%), and urinary tract infection (1.9%). Multivariate analysis revealed that decreased serum albumin level (odds ratio [OR], 0.884; 95% CI, 0.883-0.978, P < .05), presence of gallbladder stones or cholestasis (OR, 3.144; 95% CI, 1.044-9.464; P < .05), and prolonged parenteral nutrition (PN) use (OR, 1.072; 95% CI, 1.039-1.105; P < .001) were independent predictors for NIs. NIs remain prevalent in hospitalized adult patients with IF. Prolonged PN use was one of the most significant predictors for NIs.

Potential thiamine deficiency and neurological symptoms in patients receiving chemotherapy for gastrointestinal cancer.

The aim of this retrospective study was to search for risk factors for neurological adverse events in gastrointestinal cancer patients receiving chemotherapy and analyze the relationship between thiamine serum levels and neurological adverse events. This is a single-center retrospective observational study. We enrolled patients who were diagnosed with gastrointestinal cancer at our hospital, for whom we measured the thiamine serum levels. We then performed a multivariate analysis (logistic regression) to identify risk factors for the neurological symptoms in our cohort. We then divided the patients into two groups, with and without neurological symptoms, based on their electronic medical records. By using the Mann-Whitney U-test, we performed a comparative analysis of the thiamine serum levels between the two groups. We also used descriptive statistics to examine the presence/absence of neurological symptoms or other potentially related clinical features in patients with decreased thiamine serum levels. The logistic regression analysis detected the decrease in thiamine serum levels as a statistically significant risk factor for neurological symptoms. The analysis of the relationship between the presence/absence of neurological symptoms and thiamine serum levels showed that the thiamine serum levels were significantly lower in the group presenting neurological symptoms. Descriptive statistics showed that all the patients with decreased thiamine serum levels had either cognitive decline, attention decline, or depression symptoms, and most of them were receiving the 5-fluorouracil anticancer drug and showing decreased serum albumin levels. We also observed a slight decrease in serum sodium, vitamin B12, and folate levels. When neurological symptoms occur in patients receiving chemotherapy for gastrointestinal cancer, the measurement of thiamine serum levels may become a standard reference for treatment indication.

Serum albumin level difference in burn injury after tangential excision: A prospective cohort study.

BackgroundTangential excision in burn patients results in blood loss, with an average of 100 ml per 1% total body surface area (TBSA) excised. This substantial blood loss will be accompanied by decreasing serum albumin concentration, increasing inflammation, capillary leakage, and surgical stress. The importance of maintaining albumin level in burn injury is essential for wound healing, decreasing the susceptibility of sepsis, and preventing acute respiratory distress syndrome, the leading causes of death in burn injuries.MethodsThis was a prospective cohort study at our plastic surgery center in Bandung, West Java, Indonesia from January 2018. Serum albumin were sampled taken preoperatively and postoperatively after 24 h. Correlation to the percentage of burn tissue excised was analyzed.ResultTwenty-eight patients with burn injury were enrolled as study subjects. There was a significant drop in serum albumin after tangential excision surgery compared to prior surgery in burn patients with mean reduction of 8.6 ± 7.3% (P-value < 0.05) to the mean postoperative albumin value is 0.15 ± 0.1 g/dL. The albumin drop was correlated with blood loss (r = 0.326, P-value < 0.05) but not with the excision area (r = 0.196), length of surgery (r = −0.077) and TBSA (r = −0.213). Strong correlation was shown between excision area with the amount of blood loss (r = 0.567, P-value = 0.001).ConclusionTangential excision leads to a reduction in postoperative serum albumin concentration. The magnitude of albumin reduction strongly correlated with the amount of blood loss amount during the procedure.

Ophiopogonin D of Ophiopogon japonicus ameliorates renal function by suppressing oxidative stress and inflammatory response in streptozotocin-induced diabetic nephropathy rats.

Ophiopogonin D (OP-D) is the principal pharmacologically active ingredient from Ophiopogon japonicas, which has been demonstrated to have numerous pharmacological activities. However, its protective effect against renal damage in streptozotocin (STZ)-induced diabetic nephropathy (DN) rats remains unclear. The present study was performed to investigate the protective effect of OP-D in the STZ-induced DN rat model. DN rats showed renal dysfunction, as evidenced by decreased serum albumin and creatinine clearance, along with increases in serum creatinine, blood urea nitrogen, TGF-β1, and kidney hypertrophy, and these were reversed by OP-D. In addition, STZ induced oxidative damage and inflammatory response in diabetic kidney tissue. These abnormalities were reversed by OP-D treatment. The findings obtained in the present study indicated that OP-D might possess the potential to be a therapeutic agent against DN via inhibiting renal inflammation and oxidative stress.