Albumin Levels Research Articles

Neutrophil-Lymphocyte Ratio as a Novel Biomarker for Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Background: Early detection of diabetic nephropathy (DN) is crucial to prevent progression to end-stage renal disease. The gold standard for diagnosing DN involves urine microalbumin testing and renal biopsy. However, the availability of these diagnostic tools is limited in many healthcare facilities across Indonesia. Consequently, there is a pressing need for an alternative examination that is readily accessible and can effectively monitor the progression of DN. Methods: This cross-sectional study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, from February 2024 to May 2024. The study aimed to investigate the correlation between neutrophil-lymphocyte ratio (NLR) and urinary albumin levels in type 2 diabetes mellitus (DM) patients. NLR, calculated from complete blood counts, has emerged as a potential inflammatory marker for various conditions. A total of 65 participants diagnosed with type 2 DM were enrolled in the study. Data analysis involved Spearman's correlation test to assess the relationship between NLR and urinary albumin levels. Results: The majority of the 65 subjects were female (58.5%). The study found that 44 subjects had normoalbuminuria, 18 had microalbuminuria, and 3 had macroalbuminuria. A significant positive correlation was observed between NLR and albuminuria levels in type 2 DM patients (r = 0.795; p < 0.01). Conclusion: The study's findings suggest that NLR is a potential cost-effective biomarker for the early detection of DN in type 2 DM patients, especially in resource-limited settings. Further large-scale studies are recommended to validate these findings and establish specific NLR thresholds for predicting DN progression.

ОСОБЕННОСТИ ТЕРАПИИ И ПОВЫШЕНИЯ ФУНКЦИОНАЛЬНЫХ ВОЗМОЖНОСТЕЙ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ И ПЕРИФЕРИЧЕСКОЙ НЕЙРОПАТИЕЙ

The study is aimed at evaluating the effectiveness and safety of the moxibustion procedure in the treatment of pain and improving the functionality of the lower extremities in patients with diabetes mellitus and peripheral neuropathy. Materials and methods. The study was conducted at the Republican Clinical Hospital in Makhachkala from January to May 2024. The study involved 20 patients aged 18 to 75 years suffering from diabetes and peripheral neuropathy. The participants were randomly assigned to two groups: the moxibustion group and the control group in a ratio of 1:1. For 8 weeks, patients in the intervention group underwent moxibustion sessions three times a week, followed by a 4-week follow-up period. The assessment was performed using algometry, LANSS, VAS, NPS, and FAAM scales, as well as a 6-minute walking test. Laboratory tests included the measurement of serum HbA1c and albumin levels. Results. The moxibustion procedure resulted in a significant reduction in pain and improved physical function in the moxibustion group compared to the control group. Changes in pain scores (algometry, LANSS, VAS, and NPS) and in the 6-minute walking test were statistically significant (p<0.05). At the same time, there were no significant changes in HbA1c and albumin levels. The side effects were minimal and did not require medical intervention. Conclusions. The results of the study showed that moxibustion is an effective and safe method of treating pain and improving functional capabilities in patients with diabetic neuropathy. Despite the positive results, more extensive and lengthy studies are needed to confirm the long-term effectiveness and safety of this procedure.

Diagnostic Markers of Severe COVID-19 and Community-Acquired Pneumonia in Children From Southern India.

COVID-19 severely impacts children in India, with many developing severe pneumonia or multisystem inflammatory syndrome (MIS-C). Concurrently, non-COVID-19 respiratory viruses causing community-acquired pneumonia (CAP) have resurged. These conditions present similarly, challenging accurate diagnosis. This study aims to compare inflammatory markers and clinical parameters in children with severe COVID-19 pneumonia, non-COVID-19 CAP, and COVID-associated MIS-C. We assessed 12 mediators in serum from 14 children with severe COVID-19 pneumonia, 16 with severe non-COVID-19 CAP, and 9 with MIS-C. Clinical characteristics and routine laboratory findings at admission were recorded. Children with MIS-C had significantly higher levels of IL-1RA, IL-8, and TNF compared with those with severe COVID-19 pneumonia; and higher levels of CCL2, HGF, M-CSF, and IL-8 compared with severe non-COVID-19 CAP. GROα levels tended to be higher in severe COVID-19 pneumonia. Clinical presentations were similar, but MIS-C patients had distinct laboratory findings, including lower platelet counts and albumin levels, and higher creatinine and liver enzyme levels. MIS-C exhibited a unique inflammatory profile. IL-8 emerged as a potential biomarker for MIS-C, while increased GROα levels in severe COVID-19 pneumonia merit further exploration. Combining inflammatory markers with routine laboratory parameters may improve the diagnosis and differentiation of these conditions, enhancing patient management.

Can the supplementation of autolyzed yeast (Saccharomyces cerevisiae) affect the diet digestibility, feeding behavior, levels of blood metabolites, and performance of Dorper × Santa Ines lambs finished in feedlot?

This study aimed to evaluate the effect of autolyzed yeast (obtained from culture of Saccharomyces cerevisiae in sugarcane derivatives) supplementation on diet digestibility, feeding behavior, levels of blood metabolites associated with protein and energy metabolism, and performance of Dorper × Santa Ines lambs finished in feedlot. Twenty-four non-castrated male lambs with an average age of 4months and a body weight (BW) of 19.49 ± 3.08kg were allocated to individual pens within a covered and elevated shed. The pens had a slatted floor without bedding suspended 1.8m above the ground, and an area of 1.5 m2. The trial was set out in a completely randomized design with two treatments and twelve replicates each. The treatments consisted of a basal diet without yeast products (Control) or with yeast culture (Yeast, RumenYeast® at 5g/animal/day). Lambs were fed ad libitum with a total mixed ration (TMR) composed of 400g/kg of dry matter (DM) of Tifton 85 hay (Cynodon spp.) and 600g/kg DM of concentrate feed, and contained 146g/kg DM of crude protein and 2.30 Mcal/kg DM of metabolizable energy. The experiment was conducted over 84days, with the first 14days serving as an adaptation period. The subsequent experimental period was divided into two phases to evaluate animal performance (Days 1-63) and DM digestibility (Days 64-70). The supplementation with autolyzed yeast did not affect rumen or fecal pH, the DM digestibility, as well as the feeding behavior of lambs (the time spent on feeding, rumination, water intake, and idleness activities). In addition, yeast supplementation did not alter the serum levels of albumin, creatinine, urea, or level of plasma glucose, resulting in similar animal performance compared to the Control group. The mean values for final BW, DM intake, average daily gain, and feed conversion ratio were 37.52kg, 1.051kg/day, 0.286kg/day, and 3.74kg DM/kg gain, respectively. In the conditions of this study, the supplementation of autolyzed yeast in TMR (5g/animal/day) does not affect diet digestibility, feeding behavior, blood metabolites, or performance of lambs finished in feedlot. Regarding that metabolic and performance lamb responses were not improved, the supplementation of autolyzed yeast at the tested dose is not recommended. However, it is important to note that markers related to immunity and inflammation were not evaluated in our work, and these should be considered in future studies.

Impact of Preoperative and Intraoperative Factors on Postoperative Outcomes in Patients with Colorectal Cancer: A 10-Year Retrospective Study

Background and Objectives: Colorectal cancer is a major contributor to global cancer morbidity and mortality. Surgical resection remains the cornerstone of treatment, but postoperative complications can significantly affect patient outcomes. Identifying factors that influence postoperative morbidity and mortality is crucial for optimizing patient care. This study aims to evaluate the impact of preoperative, intraoperative, and postoperative factors on surgical outcomes in patients with colorectal cancer. Methods: A retrospective cohort study was conducted on 688 patients who underwent colorectal cancer surgery within a 10-year period. Data collected included demographic information, comorbidities, laboratory values, surgical details, and postoperative outcomes. Statistical analyses were performed using chi-square tests for categorical variables and t-tests for continuous variables. Multivariate logistic regression was used to identify independent predictors of postoperative complications and mortality. Results: Postoperative complications occurred in 28.5% of patients, and the 30-day mortality rate was 5.2%. Preoperative factors such as elevated C-reactive protein (CRP) levels (p < 0.001), low albumin levels (p = 0.003), a high American Society of Anesthesiologists (ASA) score (p < 0.001), and presence of comorbidities like diabetes and hypertension (p = 0.005) were significantly associated with increased postoperative complications. Intraoperative factors such as blood loss greater than 500 mL (p < 0.001) and longer operative time (p = 0.021) were also significant predictors of adverse outcomes. Multivariate analysis identified elevated CRP (OR 2.1, 95% CI 1.5–2.9), low albumin (OR 1.8, 95% CI 1.3–2.5), and blood loss > 500 mL (OR 2.4, 95% CI 1.7–3.4) as independent predictors of postoperative complications. Conclusions: Preoperative inflammatory markers, nutritional status, ASA score, comorbidities, and intraoperative factors like blood loss significantly influence postoperative outcomes in colorectal cancer surgery. Recognizing these risk factors allows for better preoperative optimization and surgical planning, potentially reducing postoperative morbidity and mortality.

Anticoagulation effects of nafamostat mesylate in sustained low-efficiency dialysis and its relevant factors

Objective: To investigate anticoagulation effects of nafamostat mesylate(NM) in sustained low-efficiency dialysis (SLED) and its relevant factors. Methods: Critically ill patients with kidney disease who were admitted to Zhongshan Hospital Affiliated to Fudan University and underwent SLED treatment from May to August 2024 were retrospectively included. Baseline clinical data were collected, and the activated partial thromboplastin time (APTT) and activated clotting time (ACT) were measured at the arterial end, before the filter, and at the venous end two hours post-NM anticoagulation treatment. Patients were categorized into two groups: the anticoagulation achievement group and the anticoagulation non-achievement group, based on the observed clotting status of the filter and venous reservoir following treatment completion. Multivariate logistic regression analysis was employed to identify risk factors influencing the efficacy of NM anticoagulation. Additionally, the receiver operating characteristic (ROC) curve was utilized to ascertain optimal monitoring indicators for NM anticoagulation. Results: A total of 96 patients (64 males and 32 females) aged (60±18) years undergoing SLED were included in the study, with 75 patients in the anticoagulation achievement group and 21 patients in the anticoagulation non-achievement group. No statistically significant differences were observed in baseline characteristics such as age, gender, body weight, baseline liver and kidney function, and platelet count between the two groups (all P>0.05). The proportion of patients with a baseline hematocrit (HCT)>30% was higher in the anticoagulation non-achievement group than that in the achievement group [57.1% (12/21) vs 22.7% (17/75), P=0.009]. The proportion of patients with fibrinogen (Fib)>4 g/L was also higher in the anticoagulation non-achievement group [90.5% (19/21) vs 49.3% (37/75), P<0.001]. The ultrafiltration rate in the anticoagulation achievement group was lower than that in the non-achievement group [232 (182, 353) ml/h vs 478 (289, 691) ml/h, P<0.001], and the NM dose was higher in the achievement group [35 (30, 40) mg/h vs 30 (25, 35) mg/h, P<0.001]. Multivariate logistic regression analysis revealed that high ultrafiltration rate (OR=1.489, 95%CI: 1.007-2.145, P<0.001), HCT>30% (OR=6.907, 95%CI: 1.523-18.342, P=0.009), and low albumin level (OR=0.821, 95%CI: 0.709-0.951, P=0.002) were relevant factors for poor NM efficacy. After 2 hours of NM treatment, the ratio of ACT at the venous/baseline ACT and the ratio of APTT at the venous/baseline APTT in the anticoagulation achievement group were both higher than those in the non-achievement group (both P<0.05). There was a positive correlation between APTT and ACT measured at the venous end 2 hours after NM treatment (r=0.763, P<0.001). The ROC curve analysis results showed that the area under the curve (AUC) for determining the effectiveness of NM anticoagulation using the ratio of APTT at the venous end to baseline APTT at 2 hours was 0.845 (95%CI: 0.762-0.928, P<0.001), with a cut-off value of 1.78 (sensitivity: 89.8%; specificity: 68.6%). Conclusions: Higher filtration rate, HCT>30% and lower albumin levels are identified as relevant factors for poor NM efficacy. Additionally, the ratio of venous/baseline APTT at 2 h after NM treatment may serve as a predictive indicator for assessing of NM anticoagulation.

Risk prediction models for feeding intolerance in patients with enteral nutrition: a systematic review and meta-analysis

BackgroundAlthough more risk prediction models are available for feeding intolerance in enteral-nourishment patients, it is still unclear how well these models will work in clinical settings. Future research faces challenges in validating model accuracy across populations, enhancing interpretability for clinical use, and overcoming dataset limitations.ObjectiveTo thoroughly examine studies that have been published on feeding intolerance risk prediction models for enteral nutrition patients.DesignConducted a systematic review and meta-analysis of observational studies.MethodsA comprehensive search of the literature was conducted using a range of databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), SinoMed, PubMed, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Embase. The search scope was confined to articles within the database from its inception until August 12th, 2024. The data from the selected studies should be extracted, including study design, subjects, duration of follow-up, data sources, outcome measures, sample size, handling of missing data, continuous variable handling methods, variable selection, final predictors, model development and performance, and form of model presentation. The applicability and bias risk were evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist.ResultsA total of 1,472 studies were retrieved. Following the selection criteria, 18 prediction models sourced from 14 studies were incorporated into this review. In the field of model construction, only one study employed the use of multiple machine-learning techniques for the development of a model. In contrast, the remaining studies used logistic regression to construct FI risk prediction models. The incidence of FI in enteral nutrition was 32.4–63.1%. The top five predictors included in the model were APACHE II, age, albumin levels, intra-abdominal pressure, and mechanical ventilation. The reported AUC, or area under the curve, exhibited a range of values between 0.70 and 0.921. All studies were identified as having a high risk of bias, primarily due to the use of inappropriate data sources and inadequate reporting within the analysis domain.ConclusionAlthough the included studies reported a certain degree of discriminatory power in their predictive models to identify feeding intolerance in patients undergoing enteral nutrition, the PROBAST assessment tool deemed all the included studies to carry a significant risk of bias. Future research should emphasize the development of innovative predictive models. These endeavors should incorporate more extensive and diverse sample sizes, adhere to stringent methodological designs, and undergo rigorous multicenter external validation to ensure robustness and generalizability.Systematic review registrationIdentifier CRD42024585099, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=585099.

Therapeutic Potential of Clove Oil in Mitigating Cadmium-Induced Hepatorenal Toxicity Through Antioxidant, Anti-Inflammatory, and Antiapoptotic Mechanisms

Hazardous heavy metals, particularly cadmium (Cd), are widely distributed in the environment and cause oxidative stress in various animal and human organs. Clove oil (CLO), a common aromatic spice, has been used as a traditional medication as it has potent anti-inflammatory, antioxidant, and hepatoprotective properties. Background/Objectives: This study aimed to investigate the antioxidant, antiapoptotic, and anti-inflammatory effects of clove oil (CLO) against hepatorenal toxicity induced by cadmium (Cd). Methods: Twenty rats were equally divided into four groups: a control group, a Cd group treated with 15 mg/kg b.wt CdCl2, a CLO group administered 200 mg/kg b.wt CLO, and a Cd+CLO group. All groups were orally treated for 4 weeks. Results: Cadmium (Cd) exposure caused anemia and hepatorenal damage, as evidenced by increased serum levels of urea, creatinine, uric acid, total bilirubin (including its direct and indirect fractions), and elevated activities of liver enzymes such as alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP). However, total protein and albumin levels decreased. Furthermore, there was a decrease in the levels of glutathione, glutathione transferase, and catalase in the liver antioxidant profiles. Meanwhile, malondialdehyde levels increased. Cadmium toxicity caused elevated expression of liver apoptosis markers, such as tumor necrosis factor-alpha (TNF-α) and caspase-3, and inflammation. CLO ameliorated the oxidative effects of Cd through decreasing urea (27.4%), creatinine (41.6%), liver enzymes, and hepatic apoptotic markers while increasing levels of total protein, albumin, and hepatic values of SOD (60.37%), CAT (64.49%), GSH (50.41%), and GST (9.16%). Conclusions: Hematological and biochemical parameters, as well as the antioxidant system, improved following clove oil treatment, leading to a reduction in hepatorenal damage. Therefore, it is possible to conclude that CLO protects rats from inflammation, apoptosis, and hepatorenal oxidative damage caused by Cd poisoning. Comprehensive translational research is required to validate CLO’s efficacy and safety of use in humans. Future studies should focus on elucidating the precise molecular mechanisms, optimal dosing strategies, and potential synergistic effects of CLO with other therapeutic agents.

The Effects of Chromium and Tin Present in the Environment and Seawater on Biochemical Parameters in Male Rabbits

The biochemical effects of exposure to potassium dichromate (K₂Cr₂O₇) and tin chloride (SnCl₂) on important liver and kidney function parameters and oxidative stress markers in experimental groups compared to controls are evaluated in this study. Male animals were split into three groups: a control group, a group that received K₂Cr₂O₇, and a group that received SnCl₂. Biochemical parameters, such as total protein, albumin, bilirubin, urea, creatinine, glucose, liver enzymes (AST and ALT), and plasma TBARS, were measured. The results showed that the K₂Cr₂O₇ and SnCl₂ groups had significantly lower levels of total protein and albumin than controls, indicating impaired protein synthesis. With SnCl₂ having a more noticeable effect, bilirubin levels were higher in the experimental groups, indicating hepatic impairment. Urea and creatinine levels rose as a result of both toxicants, indicating renal impairment, especially in the K₂Cr₂O₇ group. Both therapy groups had noticeably higher glucose levels, which is an indicator of metabolic problems. In line with hepatocellular damage, the experimental groups' hepatic enzyme activity (AST and ALT) was noticeably elevated. Furthermore, lipid peroxidation marker TBARS levels were markedly increased, indicating increased oxidative stress, with K₂Cr₂O₇ showing a greater effect. In summary, exposure to K₂Cr₂O₇ and SnCl₂ resulted in notable biochemical changes, with K₂Cr₂O₇ exhibiting more marked oxidative and nephrotoxic effects and SnCl₂ having a greater influence on hepatic function and protein synthesis. These results highlight the necessity of more investigation into these chemicals' toxicological processes.

Predicting acute kidney injury in trauma using extreme gradient boosting model: a temporal validation study

Abstract Background Acute kidney injury (AKI) is a significant complication in patients with trauma. The early identification of AKI in these patients poses challenges. This study aimed to predict AKI in trauma patients 24 or 48 hours in advance using an extreme gradient boosting (XGBoost) model. Methods We analyzed 17 859 trauma patients admitted to a regional trauma center between January 2015 and July 2023. Demographic, clinical, and laboratory parameters were collected. The model was developed using data until July 2021 and validated using data from August 2021. We developed models to predict AKI stages 1 to 3 and AKI stages 2 and 3 occurring 48 and 24 h later and measured predictive performance in the validation group. The models' performance was evaluated using the area under the receiver operating characteristic curve (AUROC), and feature importance was assessed through SHapley Additive exPlanations values. Results The study population exhibited an incidence of AKI of 6.6% in the development group and 5.4% in the validation group. The models demonstrated predictive performances with AUROCs of 0.864 and 0.886 for 48-hour predictions of AKI stages 1 to 3 and stages 2 and 3, and 0.904 and 0.903 for 24-hour predictions of AKI stages 1 to 3 and stages 2 and 3, respectively. Key features influencing model predictions included baseline and in-hospital serum creatinine values, injury severity score, age, lactate dehydrogenase, D-dimer, platelets, albumin, and C-reactive protein levels. Conclusions The XGBoost models effectively predicted AKI in trauma patients up to 48 h in advance using clinical data.

Clinical features, pathological characteristics, and prognosis of patients with IgA nephropathy complicated with nephrotic syndrome

Nephrotic syndrome (NS) occurs in 5-15% of patients with IgA nephropathy (IgAN), resulting in poorer long-term outcomes compared to those without NS. Clinical features and renal prognosis for patients with both NS and IgAN across different kidney pathologies have not been fully elucidated. This study included patients with primary IgAN through renal biopsy at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to November 2021 presenting with NS. Renal endpoint was defined as a 50% decrease in estimated glomerular filtration rate or progression to end-stage renal disease. A total of 207 patients with IgAN and NS were categorized into four pathological groups: IgAN with mesangial proliferative glomerulonephritis (IgAN-MsPGN) (n = 150), IgAN with minimal change disease (IgAN-MCD) (n = 49), IgAN with membranous nephropathy (IgAN-MN) (n = 7), and IgAN with membranoproliferative glomerulonephritis (IgAN-MPGN) (n = 1). Compared to the IgAN-MsPGN group, the IgAN-MCD group consisted of more males, had a younger average age, lower blood pressure, a lower prevalence of hematuria, and lower serum albumin and creatinine levels, whereas the IgAN-MN group was characterized by an older average age and lower serum creatinine levels. The IgAN-MCD group exhibited the mildest pathological changes among the groups. Of all patients, 133 were followed for an average follow-up period of 52.07 ± 44.04 months. Thirty-seven patients (27.8%) reached the renal endpoint. The IgAN-MCD group showed a higher rate of proteinuria remission and a better renal prognosis than the IgAN-MsPGN group. In conclusions, significant differences in clinicopathological features and long-term prognosis were observed among NS-IgAN patients with varying pathological phenotypes.

Effects of partial replacement of soybean meal with Chlorella vulgaris and lysozyme on diarrheal incidence, plasma biochemical parameters, and immunity of weaned piglets

IntroductionThe study aimed to investigate the effects of Chlorella vulgaris and lysozyme on growth performance, diarrhea rate, immune function, plasma biochemical parameters, and gut microbiota and metabolites of weaned piglets.MethodsThirty weaned Xiangcun black piglets (BW, 11.47 ± 1.13 kg) were randomly assigned to one of three treatment groups: corn-soybean meal-based basal diet (CON group), soybean meal replaced with 5% C. vulgaris (CHV group), and soybean meal replaced with 5% C. vulgaris and 100 mg/kg lysozyme (LYSO group).ResultsGrowth performance was not affected by C. vulgaris or C. vulgaris with lysozyme supplementation, while soybean meal partially replaced by C. vulgaris without lysozyme reduced the diarrhea rate of weaned piglets. Plasma biochemical analysis showed that plasma albumin, alkaline phosphatase, and high-density lipoprotein-cholesterol (HDL-C) levels in the CHV group and the total cholesterol and HDL-C levels in the LYSO group were higher when compared with the CON group. The LYSO group had increased interleukin (IL)-10 level in the jejunum and IL-1β level in the ileum while having a decreasing IL-6 level in the jejunum of piglets. Additionally, although Firmicutes and Megashaera_A abundances and short-chain fatty acid concentrations (including acetate, propionate, butyrate, and valerate) were reduced in the CHV group, but several beneficial bacteria (such as Actinobacteroita, Faecealibacterium, and Anaerovibrio) abundances were increased in the LYSO group.DiscussionIn summary, dietary C. vulgaris or C. vulgaris with lysozyme supplementation improved health of piglets in some contexts without affecting growth performance. Therefore, soybean meal replaced by 5% C. vulgaris with or without lysozyme as sustainable feed ingredients in piglet diets could be a viable alternative approach.

C-reactive protein/albumin ratio as a prognostic biomarker in myasthenia gravis

Aims: Limited research has explored novel inflammatory targets in myasthenia gravis (MG). This study aimed to investigate the role of the C-reactive protein (CRP)/albumin ratio (CAR) in disease activity and prognosis in MG patients. Methods: CRP, albumin, and CAR levels were compared between MG patients and healthy controls. The relationships of these parameters with MG activities of daily living (MG-ADL) scores and mortality were examined. Results: Sixty-six patients and 51 controls participated. CRP and CAR levels were significantly higher in the patient group (p=0.002, 0.003). No significant difference was found in albumin levels (p=0.154). A positive correlation was observed between the MG-ADL stage and both CRP and CAR levels (p=0.000 for both), with these markers increasing as MG-ADL worsened. A negative correlation was found between the MG-ADL stage and albumin (p=0.003). CRP, CAR, and albumin levels were significantly associated with mortality (p=0.000, 0.000, 0.005). Conclusion: Elevated CRP and CAR levels in MG patients suggest acute inflammation contributing to clinical decline. Albumin’s decrease with worsening MG-ADL suggests its value as a prognostic marker rather than a diagnostic. CAR proved to be a stronger marker than albumin for disease diagnosis, severity monitoring, and mortality prediction. Our findings could help illuminate inflammatory mechanisms in MG and other neuromuscular diseases.

Efficacy of serum lactate/albumin ratio as a prognostic biomarker in patients with ventilator-associated pneumonia

Aims: This study aims to evaluate the efficacy of the serum lactate/albumin ratio (LAR) as a prognostic marker in patients with ventilator-associated pneumonia (VAP) who are hospitalized in the intensive care unit (ICU). Methods: This single-center retrospective observational clinical study was conducted between January 1, 2022, and October 1, 2024. The study group comprised 58 patients admitted to the ICUs of Malatya Training and Research Hospital, Turkiye, with intubation but without a diagnosis of pneumonia at the time of admission. These patients were diagnosed with VAP 48 hours after intubation. The serum LAR was calculated within the first 24 hours after admission to the ICU and correlated with mortality and morbidity. Results: The mean age of the patients was 68 years, with the majority being over 65 years of age. Of the 58 patients included in the study, 43 (74.1%) ultimately succumbed to their illness. The LAR of those who died in the study was significantly higher than that of those who survived. The LAR was identified as a reliable predictor, exhibiting a sensitivity of 83.7% and a specificity of 60% when a cutoff value of 1.13 was applied. The survival time of patients with a LAR of ≤1.13 was significantly longer than that of patients with a ratio of &gt;1.13. Conclusion: In our study, the mortality prediction performance of the LAR in patients with VAP was superior to that of the serum lactate level or serum albumin level alone. Therefore, the LAR may be a useful and readily available prognostic factor for early risk stratification of VAP patients.

Unraveling diabetic kidney disease: insights from single-cell RNA sequencing.

The incidence of diabetic kidney disease (DKD) is rising annually. Diabetes leads to structural damage and dysfunction in the kidneys, clinically manifesting as progressive proteinuria and declining renal function, ultimately resulting in end-stage renal disease (ESRD). Recent findings have identified a subset of DKD known as normoalbuminuric diabetic kidney disease (NADKD), characterized by normal urine albumin levels but reduced renal function. These complex clinical presentations and underlying pathophysiology challenge traditional diagnostic and treatment approaches. Single-cell RNA sequencing (scRNA-seq), a novel experimental technique, is employed to analyze gene expression in renal tissue, blood, and urine from DKD patients, enhancing our understanding of tissue function, cellular interactions, and disease progression. This approach facilitates early screening and personalized management of DKD.

Association between preoperative serum albumin levels and length of stay in elderly patients with hip fractures: A nonlinear relationship.

Previous studies have provided relatively limited evidence in examining the impact of preoperative serum albumin levels on the length of hospital stay (LOS) in patients with hip fractures. This study aimed to elucidate the association between preoperative serum albumin levels and LOS in elderly patients with hip fractures. This retrospective cohort study included 1444 elderly patients undergoing surgical treatment for hip fractures at the Second People's Hospital of Shenzhen from January 2012 to December 2021. The main exposure variable was serum albumin level, and the outcome variable was LOS. A generalized additive model was used to identify the nonlinear relationship between serum albumin levels and LOS, and saturation effects were calculated using a two-piecewise linear regression model. Subgroup analysis was conducted using stratified logistic regression. The median LOS was 10 (8-15) days among all included patients. After adjusting for potential confounding factors (age, sex, comorbidities, hypertension, coronary heart disease, stroke, diabetes, duration of surgery, surgical method, intraoperative blood loss, red cell distribution width, estimated glomerular filtration rate, blood urea nitrogen, postoperative pneumonia, and transfer to ICU), a nonlinear relationship was found between serum albumin levels and LOS, with a turning point at 3.06. On the left side of the turning point, the effect size was not statistically significant (β = 1.84, 95% CI -1.00 to 4.68, P = .2042), while on the right side of the turning point, for every 1 g/dL increase in albumin, LOS decreased by 1.05 days (β = -1.05, 95% CI -1.90 to -0.20, P = .0162). A nonlinear relationship was observed between preoperative serum albumin levels and LOS in elderly patients with hip fractures. When albumin levels were >3.06 g/dL, they were negatively correlated with LOS. This has important implications for clinicians in the development of nutritional improvement strategies.

High Volume Plasma Exchange Improves Survival Rates in Surgical Critically Ill Patients With Medical Jaundice and Hepatic Failure: A Comparative Study.

Acute liver failure poses a significant challenge in surgical critically ill patients. Treatments typically focus on physiological support and alleviation of hepatic insult. This study aims to evaluate the role of high-volume plasma exchange (HVPE) in surgical critically ill patients with medical jaundice and hepatic failure. A retrospective review was conducted on surgical critically ill patients with hepatic failure unresponsive to conventional therapy, excluding those with obstructive jaundice. HVPE was considered for patients with persistent hyperbilirubinemia (>10mg/dL) and coexisting conditions such as coagulopathy, hyperammonemia, more than Grade II hepato-encephalopathy, or exacerbated sepsis/septic shock status or multiple organ failure. Patients were categorized into standard medical treatment (SMT) and SMT+HVPE groups. Demographics and laboratory data were collected for analysis. A total of 117 patients were enrolled, with 79 in the SMT group and 38 in the SMT+HVPE group. There were no significant differences in laboratory data and MELD score upon admission. Before treatment, patients in the SMT+HVPE group exhibited higher levels of T-bil., D-bil., and sugar than the SMT group. After treatment, the SMT+HVPE group showed lower serum D-bil. and AST levels but higher levels of albumin and platelets compared to the SMT group. The SMT+HVPE group demonstrated significantly lower delta T-bil., delta D-bil., and higher delta platelet levels. The survival rate was 31.6% (12/38) in the SMT+HVPE group and 1.3% (1/79) in the SMT group. The in-hospital mortality rate in the SMT+HVPE group was lower than that in the SMT group, with a hazard ratio of 0.42 in the crude model and 0.34 (95% CI=0.20-0.60 and p=0.0002) in the adjusted model. Our findings suggest that HVPE improves survival rates in surgical critically ill patients with medical jaundice and hepatic failure. However, due to its retrospective nature, further studies were warranted.

Nutritional changes in patients undergoing hemodialysis who develop COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) is known to deteriorate nutrition in the general population. However, the influence of COVID-19 on the nutritional status of patients undergoing maintenance hemodialysis remains unclear.MethodsA retrospective study was conducted in a hospital that had an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. COVID-19 was diagnosed using an antigen test, and the subjects were divided into COVID-19 and control groups. Data on body mass index, biochemistry measurements, geriatric nutritional risk index (GNRI), functional oral intake scale, and nutritional intake were collected from medical records. A generalized linear mixed model was used to analyze the interaction of time × group for these parameters between the two groups.ResultsThe study included 28 participants, 16 of whom belonged to the COVID-19 group. There were no significant differences in baseline characteristics, except for serum creatinine level, among the groups. In the COVID-19 group, 63% exhibited anorexia and 50% experienced vomiting/nausea. Nutritional support or dietary consultations were provided to nine patients. Significant declines were observed in serum albumin level, total iron binding capacity, energy intake, and GNRI in the COVID-19 group, and these nutritional parameters recovered within 1 month following the resolution of the infection.ConclusionsCOVID-19 deteriorated nutritional status in patients undergoing hemodialysis. More proactive nutritional support may help maintain the nutritional status of patients undergoing hemodialysis during COVID-19 infection and could lead to a better prognosis.

Sequential Versus Continuous Feeding and Its Effect on the Gut Microbiota in Critically Ill Patients: A Randomized Controlled Trial.

Gut microbiota disturbance may worsen critical illnesses and is responsible for the progression of multiple organ dysfunction syndrome. In our previous study, there was a trend towards a higher α-diversity of the gut microbiota in sequential feeding (SF) than in continuous feeding (CF) for critically ill patients. We designed this non-blinded, randomized controlled study to confirm these results. All the enrolled patients received continuous feeding in the beginning. After achieving ≥80% of the nutrition target calories (25-30 kcal/kg/d), the patients were randomized into the SF group or the CF group. In the SF group, continuous feeding was changed into intermittent feeding. The total daily dosage of enteral nutrition was equally distributed during three periods at 7-9:00, 11-13:00 and 17-19:00. After 7 days of randomization, fresh stool and serum were collected for 16S rRNA gene sequencing and untargeted metabolomics analysis respectively. Meanwhile, routine blood test indicators and metabolic indicators were recorded. Finally, data from 65 patients in the SF group and 69 patients in the CF group were used for intention-to-treat analysis. There was no difference in the Shannon index between the SF group and CF group [2.5 (1.7-3.4) vs. 2.6 (1.5-3.5), P =0.934]. However, at the genus level, the abundances of Erysipelotrichaceae_UCG-003 and Howardella increased in the SF group. Some metabolic indicators (the albumin level, total cholesterol level and total bile acid level) and the increases in lymphocyte counts in the SF group were different from those in the CF group (P <0.05). In untargeted metabolomic analysis, 58 differentially abundant metabolites between the two groups were found. The pathway with the highest enrichment factors was primary bile acid biosynthesis according to the Kyoto Encyclopedia of Genes and Genomes Database classification. Regarding adverse events, the gut tolerance, average glucose and incidence of hyperglycemia and hypoglycemia were similar between the SF group and CF group. The mortality rate in the SF group was lower than that in the CF group, but there was no statistical difference (9.2% vs. 13.0%, P=0.484). SF did not increase the diversity of gut microbiota in critically ill patients. However, it did alter the abundances of some gut microbes and affect some metabolites. Its clinical significance requires further exploration. In addition, the gut tolerance and safety of SF were similar to that of CF. www. gov, registration number NCT04443335. Registered 21 June, 2020.

Population pharmacokinetics of bedaquiline: a systematic review.

Bedaquiline (BDQ) plays a critical role in the treatment of multidrug-resistant tuberculosis (MDR-TB). However, the large pharmacokinetic (PK) variability of BDQ presents a significant challenge in its clinical use. This study aimed to summarize the population PK characteristics of BDQ and to identify significant covariates affecting the PK variation of BDQ. The PubMed and Web of Science databases were systematically searched from their inception to October 1, 2023. Population pharmacokinetics (PPK) studies on BDQ were searched and identified in this review. The PK characteristics of included studies and the significant covariates were systematically summarized. Eight studies conducted in adults and one in children and adolescents were included in this review. A three disposition compartments with dynamic absorption transport chamber model was the commonly used structural model for BDQ. Body weight, race, albumin, and concomitant medication were significant covariates affecting BDQ PK variation. With the increase of weight and albumin levels, the clearance (CL) of BDQ was gradually increased. The average CL value per body weight in children was 1.49-fold higher than that in adults. Black race patients had an 84% higher CL than other populations. Moreover, combined with rifampicin and rifapentine, BDQ had 378% and 296% higher clearance rates, respectively. Body weight, race, albumin level, and concomitant medication may be important factors affecting patients' exposure differences. Further PPK studies of BDQ are needed to facilitate optimal dosing regimens.