non-DN Group Research Articles

Serum C-reactive protein to albumin ratio as a reliable marker of diabetic neuropathy in type 2 diabetes mellitus.

In various diseases characterized by inflammation, the C-reactive protein to albumin ratio (CAR) serves as a marker of inflammation. Type 2 diabetes mellitus (T2DM) is frequently complicated by diabetic neuropathy (DN) and timely diagnosis is crucial for treatment and potential reversal of this complication. Since both DN and T2DM are associated with chronic, low-grade inflammation, our study aimed to evaluate CAR levels in type 2 diabetic subjects with DN and compare them to those in subjects without DN. Patients presenting to our institutional outpatient clinics were divided into two groups based on the presence of DN. Data on characteristics and laboratory measures, including CAR,were compared between the DN and non-DN groups. The median CAR in the DN and non-DN groups was 2.19% (range 0.2%-49%) and 0.56% (range 0.02%-5.8%), respectively (P < 0.001). CAR showed significant positive correlations with weight (r = 0.19, P = 0.01), body mass index (BMI) (r = 0.11, P = 0.03), waist circumference (r = 0.10, P = 0.046), fasting glucose (r = 0.14, P = 0.004), serum creatinine (r = 0.25, P < 0.001), triglyceride (r = 0.17, P < 0.001), and LDL-cholesterol (r = 0.13, P = 0.001) levels, and an inverse correlation with estimated glomerular filtration rate (eGFR) (r = -0.16, P < 0.001). Additionally, CAR demonstrated a sensitivity of 78% and specificity of 73% for predicting DN at a threshold of 1.02% (area under curve [AUC] 0.84, 95% confidence interval [CI] 0.82-0.87, P < 0.001). High CAR levels were independently associated with an increased risk of DN (odds ratio [OR] 1.34, 95% CI 1.08-1.62, P < 0.001). Elevated CAR levels may thus be considered a potential marker for DN in T2DM patients.

Establishment of a metabolite diagnostic model for the risk of diabetic nephropathy in type 2 diabetic population: Based on a cross-sectional study in China

IntroductionThis study aimed to investigate the correlation between various plasma metabolites and the likelihood of developing diabetic nephropathy (DN) and construct a diagnostic model for DN in Chinese patients with type 2 diabetes mellitus (T2DM). MethodsA cross-sectional investigation was conducted in a hospital setting. Based on medical data, a total of 743 patients from a tertiary hospital were selected and categorized into two groups: the diabetic nephropathy group (DN group) and the non-diabetic nephropathy group (non-DN group). Plasma levels of metabolites, including amino acids and acylcarnitines, were determined using a laser counter measurement system (LC-MS). Subsequently, partial least-squares regression was used to assess the significance of these metabolites. Receiver operating characteristic (ROC) curves were generated for factors that ranked highest in terms of relevance. Model performance was assessed using the curve (AUC). ResultsOf the 743 patients with T2DM admitted to the hospital, 145 had DN. Compared with the non-DN group, the DN group exhibited elevated systolic blood pressure (P ​= ​0.001), high-density lipoprotein cholesterol (P ​= ​0.01), and low-density lipoprotein cholesterol (P ​= ​0.042). Additionally, the DN group had a higher prevalence of stroke patients (P ​< ​0.001) and diabetic retinopathy patients (P ​< ​0.001). Finally, a risk model that included citrulline, leucine, tyrosine, valine, propionylcarnitine (C3), and palmitoylcarnitine (C16) was developed. This model achieved an AUC of 0.709, with a 95% confidence interval (CI) ranging from 0.626 to 0.793. ConclusionsA diagnostic model consisting of six plasma metabolites to assess the risk of DN in Chinese patients with T2DM may provide clues for future research.

Clinical study of different prediction models in predicting diabetic nephropathy in patients with type 2 diabetes mellitus.

Among older adults, type 2 diabetes mellitus (T2DM) is widely recognized as one of the most prevalent diseases. Diabetic nephropathy (DN) is a frequent complication of DM, mainly characterized by renal microvascular damage. Early detection, aggressive prevention, and cure of DN are key to improving prognosis. Establishing a diagnostic and predictive model for DN is crucial in auxiliary diagnosis. To investigate the factors that impact T2DM complicated with DN and utilize this information to develop a predictive model. The clinical data of 210 patients diagnosed with T2DM and admitted to the First People's Hospital of Wenling between August 2019 and August 2022 were retrospectively analyzed. According to whether the patients had DN, they were divided into the DN group (complicated with DN) and the non-DN group (without DN). Multivariate logistic regression analysis was used to explore factors affecting DN in patients with T2DM. The data were randomly split into a training set (n = 147) and a test set (n = 63) in a 7:3 ratio using a random function. The training set was used to construct the nomogram, decision tree, and random forest models, and the test set was used to evaluate the prediction performance of the model by comparing the sensitivity, specificity, accuracy, recall, precision, and area under the receiver operating characteristic curve. Among the 210 patients with T2DM, 74 (35.34%) had DN. The validation dataset showed that the accuracies of the nomogram, decision tree, and random forest models in predicting DN in patients with T2DM were 0.746, 0.714, and 0.730, respectively. The sensitivities were 0.710, 0.710, and 0.806, respectively; the specificities were 0.844, 0.875, and 0.844, respectively; the area under the receiver operating characteristic curve (AUC) of the patients were 0.811, 0.735, and 0.850, respectively. The Delong test results revealed that the AUC values of the decision tree model were lower than those of the random forest and nomogram models (P < 0.05), whereas the difference in AUC values of the random forest and column-line graph models was not statistically significant (P > 0.05). Among the three prediction models, random forest performs best and can help identify patients with T2DM at high risk of DN.

Association of Serum Unsaturated Fatty Acid Patterns with the Risk of Diabetic Nephropathy

Introduction: Unsaturated fatty acids play an essential role in the progression of diabetic nephropathy (DN). However, previous studies were mainly focused on the role of individual unsaturated fatty acid. The serum unsaturated fatty acid patterns (FAPs) in patients with DN remain to be determined. Methods: A total of 135 patients with DN (DN group) and 322 patients with type II diabetes without nephropathy (non-DN group) were included in this study. Clinical data, serum levels of unsaturated fatty acids, and other laboratory indicators were collected. Multivariate logistic regression was applied to identify risk factors for serum unsaturated fatty acid level in both groups. Serum unsaturated fatty acids were subjected to factor analysis to identify distinct FAPs. Multivariable logistic regression was employed to assess the risk of DN associated with different serum FAPs. Results: After adjusting for confounders, three types of unsaturated fatty acid including C20:5 (eicosapentaenoic acid [EPA]), C22:6 (docosahexaenoic acid [DHA]), and C22:5 n-3 (docosapentaenoic acid n-3) were significantly associated with DN in the population. The odds ratios (ORs) (95% confidence interval [CI]) of DN were 0.583 (0.374, 0.908), 0.826 (0.716, 0.954), and 0.513 (0.298, 0.883), respectively. Factor analysis revealed five major FAPs, among which FAP2 (enriched with EPA and DHA) exhibited a significant inverse association with DN. In the multivariate-adjusted model, the OR (95% CI) was 0.678 (0.493, 0.933). Additionally, a combination of DHA and EPA enriched in FAP2 further decreased extracellular matrix production induced by transforming growth factor beta 1 in podocytes and tubular cells. Conclusions: Our findings suggest that FAP2 which is enriched with DHA and EPA is associated with a reduced risk of DN. This highlights the potential of targeting FAP2 for the patients with DN.

The neutrophil-to-lymphocyte ratio is associated with the frequency of delayed neurologic sequelae in patients with carbon monoxide poisoning

Delayed neurologic sequelae (DNS) is a common complication in patients with carbon monoxide poisoning (COP). We aimed to investigate the association of the neutrophil-to-lymphocyte ratio (NLR) with the frequency of DNS in COP patients. A total of 371 COP patients were investigated in retrospective and prospective studies. A receiver operator curve (ROC) test was performed to evaluate the ability of the NLR to predict DNS in COP patients. The retrospective study included 288 COP patients, of whom 84 (29.2%) were confirmed to have DNS, and 1 (0.3%) died within 28 days. The NLR in the DNS group was significantly higher than that in the non-DNS group (6.84 [4.22–12.43] vs. 3.23 [1.91–5.60] × 109/L). NLR was a significant predictor of the frequency of DNS [odds ratio (OR): 1.130, 95% confidence interval (CI): 1.030, 1.240] in COP patients. The area under the ROC curve of NLR for predicting DNS was 0.766 (95% CI 0.701, 0.832), and the cut-off value was 3.745 (sensitivity, 83.3%; specificity, 58.8%). The prospective study included 83 COP patients, of whom 19 (22.9%) were confirmed to have DNS, and all patients survived. Moreover, the frequency of DNS in the patients with an NLR ≥ 3.745 was notably higher than that in the patients with an NLR < 3.745 [41.4% (12/29) vs. 13.0 (7/54)]. In conclusion, the NLR was a significant, independent predictor of the frequency of DNS in COP patients.

Presence of Non-Diabetic Kidney Diseases in Biopsy Specimens of Diabetic Patients' Single Center Experience.

The complications of type 2 diabetes mellitus (T2DM) are well known and one of them is diabetic chronic kidney disease (DCKD). Over time, it has become clear that patients with T2DM can have nondiabetic chronic kidney diseases (NDCKD), especially those that affect the glomeruli. Clinical indicators for identifying DCKD from NDCKD with high sensitivity and specificity have not yet been identified. Therefore, kidney biopsy remains the golden standard for DCKD diagnosis in patients with T2DM. Despite some indications for kidney biopsy, criteria for a biopsy differ between countries, regions, and doctors. The aim of the study was to analyze the biopsy findings in our T2DM population and the justification of the biopsy according to widely accepted criteria. This single center retrospective study analyzed data from 74 patients with T2DM who underwent kidney biopsy from January 2014 to January 2021. According to the biopsy data, we categorized31 patients in the DN group, patients with typical diabetic glomerulopathy, 11 patients in the mixed group, patients who had pathohistological elements for both DN and non-DN glomerulopathy, and 32 patients in the non-DN group, patients with primary glomerulopathy not linked with DM. In the non-DN and mixed groups, the most frequent glomerulopathy was mesangioproliferative glomerulonephritis, including IgA and non-IgA forms, found in 10 patients, and membranous nephropathy (MN) in 10 patients. We analyzed several parameters and only the amount of proteinuria was found to be significantly linked to biopsy findings related to DN. With the existing criteria for kidney biopsy, we managed to detect changes in the kidneys in about half of our patients with T2DM. These patients required specific treatment, different from that which we use for DCKD patients.

Correlation Between Blood Glucose Indexes Generated by the Flash Glucose Monitoring System and Diabetic Vascular Complications.

To discuss the relationship between time in range (TIR) which is deprived of the FGMS and the risk of diabetic vascular complications and to provide a theoretical foundation for the clinical application of TIR and other FGMS-deprived indexes. Patients with T2DM who wore the FGMS sensor continuously were enrolled. Relevant indexes such as TIR, time below range (TBR), time above range (TAR), a standard deviation of blood glucose (SDBG), coefficient of variation of blood glucose (CV), and mean amplitude of glycemic excursion (MAGE) generated by the FGMS were recorded, and the risk of diabetic vascular complications were followed up for one year. The TIR was measured by continuous glucose monitoring at baseline, and patients were grouped according to TIR every 20%. Finally, the Cox proportional hazards regression model was used to estimate the association of different levels of TIR with different rates of diabetic vascular complications. TIR was negatively correlated with HbA1C, CV, SDBG, and amplitude of glycemic excursion (MV), wherein, the lower the TIR, the higher the HbA1C, CV, SDBG, and MV. TIR in the diabetic microvascular complication was significantly lower than that in the non-microvascular complication group, and the difference was statistically significant. TIR <40% was identified as a risk factor for DN, DPN, and DR according to the risk assessment. The mean TAR in the DN group was significantly higher than that in the non-DN group. TAR, CV, SD, MAGE, and HbA1C in the DR group were significantly higher than those in the non-DR group. TAR, ABG, CV, SD, MAGE, and HbA1C in the DPN group were significantly higher than those in the non-DPN group. The relationships between the TIR and the prevalence and risk of diabetic vascular complications and the HbA1C may be negative. Other CGM-deprived indexes such as CV and MV should be integrated into glycemic control and diabetes complication prediction.

Serum neurofilament light chain for predicting delayed neurological sequelae after acute carbon monoxide poisoning.

Acute carbon monoxide (CO) poisoning survivors may experience persistent delayed neurological sequelae (DNS). No studies have investigated the serum neurofilament light chain (NFL) as a prognostic biomarker in acute CO poisoning. This study aimed to determine the serum NFL levels to predict the DNS after acute CO poisoning. Patients with acute CO poisoning who were consecutively admitted from October 2020 to September 2022 were included. The predictive performance of NFLs for the DNS was assessed through the analyses of the correlation, the logistic regression, and the receiver operating characteristic (ROC) curve. Overall, 9.7% (15/155) of the patients had DNS. The serum NFLs in patients with DNS was 113.7pg/mL, which is significantly higher than that in the non-DNS group (25.8pg/mL; P < 0.001). Correlation analysis shows that the serum NFLs are positively correlated with DNS (r = 0.567, P < 0.001). After multiple adjustments, the serum NFLs are independently correlated with DNS [adjusted odds ratio1.032; 95% confidence interval (CI)1.001, 1.064; p = 0.043]. The ROC curve indicates an area under the curve (AUC) of 0.923 (95% CI0.869, 0.960), with a sensitivity of 100% and a specificity of 84.3% at the best cutoff value of 73.4pg/mL. Pairwise comparison shows that the AUC of the NFL is significantly higher than that of the neuron specific enolase (AUC = 0.779) using the Hanley and McNeil test (Z = 2.283, p = 0.022). Serum NFL could be a biomarker of the DNS after acute CO poisoning.

Potential Role and Expression Level of Urinary CXCL8 in Different Stages of Incipient Diabetic Nephropathy with Undiminished Creatinine Clearance: A Pilot Study.

Diabetic nephropathy (DN) is one of the most devastating microvascular complications of diabetes, with a high prevalence and poor prognosis. Early intervention is crucial to improve the outcomes of DN. CXCL8 is related to podocyte damage in incipient DN; however, the role and expression level of CXCL8 have never been elucidated, especially in those with undiminished creatinine clearance. Consecutive inpatients with type 2 diabetes were included in this study. Patients were assigned into four groups based on the Mogensen stage, reflecting pathological features through clinical manifestations: non-DN group, hyperfiltration group, microalbuminuria group and overt DN group. Clinical and laboratory data were retrospectively collected and analyzed. Urinary CXCL8 (uCXCL8) was measured using an enzyme-linked immunosorbent assay (ELISA) method and adjusted for urinary creatinine (Cr) from the same urine sample. In total, 88 eligible consecutive inpatients with type 2 diabetes were included in this study. uCXCL8 was differentially expressed in different stages of incipient DN; it decreased in the hyperfiltration phase of incipient DN (1.40±1.01 pg/μmol Cr) and was highly expressed in patients in the microalbuminuria stage (5.01±4.01 pg/μmol Cr). uCXCL8 was positively correlated with age, diabetes course, cystatin C and urinary albuminuria-to-creatinine ratio, but negatively correlated with estimated glomerular filtration rate (P<0.05). uCXCL8 was a risk factor for classic DN after adjusting for age, diabetes course and cystatin C (OR=1.17, 95% CI 0.98-1.4, P=0.045). CXCL8 played an important role in the progression of incipient DN. The unique expression profile of uCXCL8 may provide a reference for understanding the prognosis and mechanisms of incipient DN progression. uCXCL8 was an independent risk factor for the development of classic DN.

Association between brachial-ankle pulse wave velocity and microvascular complications in type 2 diabetes mellitus

Purpose/AimTo investigate the relationship between brachial-ankle pulse wave velocity (baPWV) and microvascular complications in type 2 diabetes mellitus (T2DM).Materials and methodsFrom 2019 to 2021, our hospital enrolled 322 patients with T2DM. Clinical information and biochemical indicators of patients were collected from the inpatient electronic medical record system and analyzed retrospectively. Fundus photography, nerve conduction testing, and sensory threshold measurement were all conducted on the subjects. We measured the pulse wave velocity on both sides of the arm and ankle, then averaged the results. The enrolled cases were divided into two groups based on the baPWV: Group 1 (<the reference cutoff value, n = 160) and Group 2 (≥ the reference cutoff value, n = 162). The association between associated factors and baPWV abnormalities was investigated using a logistic regression model.ResultsGroup 2 had higher Systolic Blood Pressure(SBP), Diastolic Blood Pressure (DBP), duration of diabetes, Fasting Plasma Glucose (FPG), Blood Urea Nitrogen (BUN) and Serum Uric Acid (SUA) than group 1 (all p < 0.05). The prevalence of diabetic retinopathy, peripheral neuropathy and nephropathy in group 2 was higher compared to group 1 (p < 0.05). After classifying subjects according to the presence or absence of diabetic complications, we found that the baPWV of the Diabetic Peripheral Neuropathy (DPN) group and Diabetic Nephropathy (DN) group was noticeably higher than that of non-DPN group and non-DN group, respectively (both p < 0.05). The baPWV increased with the aggravation of Diabetic Retinopathy (DR) (p < 0.05). Multivariate logistic regression analysis showed that DBP (OR 1.039, 95%CI 1.010–1.068 p = 0.008), duration of diabetes (OR 1.059, 95%CI 1.017–1.103 p = 0.006), FPG (OR 1.104, 95%CI 1.025–1.188 p = 0.009) and BUN (OR 1.128, 95%CI 1.001–1.270 p = 0.048) were all independently and positively associated with baPWV.ConclusionsThe baPWV is strongly associated with microvascular complications of T2DM. The DBP, duration of diabetes, FPG, and BUN were all independent associated factors of baPWV.

Is preclinical diabetic retinopathy in diabetic nephropathy individuals more severe?

To analyse the retinal vessel density and thickness characteristics of diabetic nephropathy (DN) individuals with preclinical diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA). This retrospective case-control study included 88 eyes of 88 type 2 DM patients with preclinical DR [44 non-DN (NDN) and 44 DN]. OCTA images and data were acquired using AngioVue 2.0 of the spectral domain OCT device. The foveal avascular zone (FAZ) area, superficial capillary plexus (SCP) and deep capillary plexus vessel densities, ganglion cell complex (GCC) and full retinal thicknesses, peripapillary capillary density and nerve fibre layer (RNFL) thickness were compared between the NDN and DN groups. The relationship between each renal function parameter and each OCTA parameter was analysed. SCP vessel density, GCC thickness and full retinal thickness were significantly reduced in DN individuals compared to NDN individuals [(NDN versus DN) SCP vessel density: 46.65 ± 3.84% versus 44.35 ± 5.25%, p=0.030; GCC thickness: 100.79 ± 5.92 μm versus 93.28 ± 8.66 μm, p<0.001; full retinal thickness: whole area: 287.04 ± 13.62 μm versus 277.71 ± 15.10 μm, p=0.005). Within the peripapillary area, capillary density was also significantly reduced in the whole area (50.19 ± 3.10% versus 47.46 ± 5.93%, p=0.016) and some sectors in the DN group, though RNFL thickness was only decreased in some sectors. For all individuals, estimated glomerular filtration rate (eGFR) correlated significantly with most OCTA parameters and then showed a significantly negative correlation with FAZ area (β=-16.43, p=0.039) in multivariate linear regression analysis. In the NDN group, eGFR showed a significantly negative correlation with FAZ area (β=-18.746, p=0.048) and a significantly positive correlation with SCP vessel density (β=0.580, p=0.036). Preclinical DR may be more severe in DN individuals than in NDN individuals with regard to microvascular and microstructural impairment. Moreover, eGFR may be a good indicator for retinal microvascular impairment.

The relationship between serum γ-glutamyltransferase (GGT) and diabetic nephropathy in patients with type 2 diabetes mellitus: a cross-sectional study.

The relationship between serum γ-glutamyltransferase (GGT) and renal dysfunction is controversial. In this study, we examined the relationship of serum GGT to diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). A total of 577 patients with T2DM were enrolled and their basic information and laboratory data were collected and analyzed. The prevalence of DN increased with the elevated serum GGT tertiles. The level of serum GGT in the DN group was higher than in the non-DN groups. Multivariate logistic analysis showed that high GGT was independent risks for DN (OR = 1.041, 95% CIs 1.023-1.059). And the OR of log-transformed serum GGT for DN was 6.190 (95% CIs 4.248-9.021). The OR of DN across increasing tertiles of serum GGT were 1.00, 3.288 (1.851-5.840), and 5.059 (2.620-9.769) (P for trend < 0.001). Stratified receiver operating characteristic (ROC) analysis by gender showed that the area under ROC curve (AUC) value for GGT was 0.781 (0.732-0.825, P < 0.05) in male and was 0.817 (0.761-0.864, P < 0.05) in female. Compared with female, GGT in male showed lower sensitivity (52.86% vs. 82.05%) and higher specificity (90.32% vs. 55.26%). And the AUC value for GGT was greater than creatinine (Cr) and estimated glomerular filtration rate (eGFR) in male and smaller than Cr and eGFR in female, respectively. In Conclusion, there was an independently positive relationship between serum GGT levels and DN, which suggested that elevated GGT was a potential indicator for risk of DN. There were gender differences in the predictive property of GGT for DN.

Dysregulation of Long Noncoding RNA NEAT1/miR-199a-5/BiP Axis in Patients with Diabetic Neuropathy.

Diabetic neuropathy (DN) is a type of nerve damage and the most common complication of diabetes. Regarding the association between endoplasmic reticulum (ER) stress with the pathogenesis of neuropathy, this study aims to examine binding immunoglobulin protein (BiP) gene expression and long noncoding RNA nuclear enriched abundant transcript 1 (NEAT1), miR-199a-5 as its regulator in the peripheral blood of DN patients compared to diabetic patients without neuropathy. Peripheral blood samples were obtained from DN (n = 20) patients and diabetic patients without neuropathy (non-DN) (n = 20). After RNA extraction from peripheral blood mononuclear cells, reverse transcription-quantitative polymerase chain reaction was performed to evaluate RNA expression. The results showed that the expression level of NEAT1 and BiP genes in the DN group increased significantly compared to the non-DN group. Also, the expression level of miR-199a-5p in the DN group was significantly downregulated. As a result, the axis of NEAT1, miR-199a-5p, and BiP may have a role in the DN pathogenesis.

A Novel Study of Protein Kinase C Beta Gene Polymorphism (rs3760106) and Protein Kinase C Activity Levels as a Predictor of Nephropathy Complications in Iraqi Diabetic Patients

Objective: This study aimed to investigate the relation between the risk of (PRKCB-1504 C/T) gene polymorphisms and diabetic nephropathy pathogenesis and its association with its levels and some other biomarkers in serum of Iraqi diabetic nephropathy patients.&#x0D; Methods: A cross-sectional study was performed on 130 samples obtained from Al-Hussein Teaching Hospital / Kerbala – Iraq during Feb., 2020 to March. 2021. Seventy three patients of them with type 2 diabetes mellitus (T2D) and the remaining patients with type 2 diabetes mellitus with nephropathy complications (DN). Phenotypic analysis included determination of protein kinase C (PKC) activity levels, HbA1c%, serum insulin levels and renal function tests. Five ml of whole blood was obtained from each patients, 4.0 ml was centrifuged for serum separation used for biomarkers determinations and the remaining 1.0 ml was used for genomic DNA extraction for molecular analysis and polymorphism of PRKCB (rs3760106) by allele specific-amplification refractory mutational system-polymerase chain reaction (allele specific ARMS-PCR), followed by electrophoresis on 1% agarose gel. Various statistical analyses were applied to analyze the obtained data.&#x0D; Results: The amplification of the PRKCB gene gives one genotypes as indicated by (200 bp) bands for those with homozygous wild type (CC), homozygous mutant (TT) genotypes and two genotypes bands (200 bp) for those with heterozygous (CT). Genotype frequencies of rs3760106 polymorphism were found to be consistent with Hardy–Weinberg equilibrium. Allele frequencies (23.3 %, 26.7 %, 50 %) of CC, CT, TT in cases of DN group. While the frequencies in the non-DN group were (30 %, 45%, 25%) and for healthy control group were (50%, 33.4%, 16.6%) for wild, heterozygous, and homozygous in an order. In healthy control group, the risk of diabetic nephropathy was significantly higher among carriers of T allele under codominant TT (OR=6.42, 95%CI=(1.66-24.85), P=0.007), dominant CT+TT (OR=3.2, 95%CI = (1.08-9.95),P=0.03) and recessive model (OR=5, 95%CI = (1.51-16.56), P=0.008) while in T2DM without nephropathy the risk of diabetic nephropathy was significantly higher among carrier of T allele under recessive model (0R=3, 95%CI = (1.09-28.25), P= 0.003). Serum level of PKC-B1 activity was significantly higher among DN group than T2DM and control groups (43.35 ± 18.69, 30.35 ± 11.96, 27.42 ± 10.31, P=0.001), also PKC-B1 activity in DN group was significantly correlated with fasting blood glucose, HOMA-IR and renal function tests such as GFR, urea and creatinine.&#x0D; Conclusion: This study indicates that the PRKCB (C/T-1504) rs3760106 single nucleotide polymorphism was significantly associated with increased diabetic nephropathy susceptibility of Iraqi patients with T2DM and serum level of PKCB activity was associated with increase the risk of diabetic nephropathy complications.

Association between Early Phase Serum Lactate Levels and Occurrence of Delayed Neuropsychiatric Sequelae in Adult Patients with Acute Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis.

The primary goal of treating carbon monoxide (CO) poisoning is preventing or minimizing the development of delayed neuropsychiatric sequelae (DNS). Therefore, screening patients with a high probability for the occurrence of DNS at the earliest is essential. However, prognostic tools for predicting DNS are insufficient, and the usefulness of the lactate level as a predictor is unclear. This systematic review and meta-analysis investigated the association between early phase serum lactate levels and the occurrence of DNS in adult patients with acute CO poisoning. Observational studies that included adult patients with CO poisoning and reported initial lactate concentrations were retrieved from the Embase, MEDLINE, Google Scholar and six domestic databases (KoreaMED, KMBASE, KISS, NDSL, KISTi and RISS) in January 2022. Lactate values were collected as continuous variables and analyzed using standardized mean differences (SMD) using a random-effect model. The risk of bias was evaluated using the Quality in Prognosis Studies (QUIPS) tool, and subgroup, sensitivity and meta regression analyses were performed. Eight studies involving a total of 1350 patients were included. The early phase serum lactate concentration was significantly higher in the DNS group than in the non-DNS group in adult patients with acute CO poisoning (8 studies; SMD, 0.31; 95% CI, 0.11–0.50; I2 = 44%; p = 0.002). The heterogeneity decreased to I2 = 8% in sensitivity analysis (omitting Han2021; 7 studies; SMD, 0.38; 95% CI, 0.23–0.53; I2 = 8%; p < 0.001). The risk of bias was assessed as high in five studies. The DNS group was associated with significantly higher lactate concentration than that in the non-DNS group.

Prediction of delayed neuropsychiatric sequelae after carbon monoxide poisoning via serial determination of serum neuron-specific enolase levels.

Neuron-specific enolase (NSE) is released into serum when nerve cells are damaged, and the levels thereof are used to determine neurological prognosis in patients who have suffered cardiac arrest or stroke. Delayed neuropsychiatric sequelae (DNS), a major complication of carbon monoxide poisoning (COP), can be caused by inflammatory response which is a mechanism of neuronal injury in cardiac arrest and stroke. NSE is known as a predictor of neurological prognosis in ischemic brain injury after cardiac arrest, and it is also reported as a predictor of DNS in acute COP. When serum NSE is measured serially in cardiac arrest patients, the best time to predict neurological prognosis is known at 48-72h, but there are no studies analyzing serial serum NSE in acute COP. Thus, we explored whether serum NSE levels measured three times at 24h intervals after COP predicted the development of DNS. This prospective observational study was conducted on patients treated for COP from May 2018 to April 2020 in a tertiary care hospital in Korea. Neuron-specific enolase levels were assessed 24, 48, and 72h after presentation at hospital. We used logistic regression to explore the association between NSE levels and DNS development. The NSE level was highest at 48h, and the difference between the DNS group and the non-DNS group was greatest on the same time point. On multivariable logistic regression analysis, the NSE level at 48h of >20.98ng/mL (odds ratio [OR], 3.570; 95% confidence interval [CI], 1.412-9.026; P = .007) and the initial Glasgow Coma Scale (GCS) score of <9 (OR, 4.559; 95% CI, 1.658-0.12.540; P = .003) was statistically significant for DNS development. Early identification of those who will experience DNS in acute COP patients is clinically important for deciding treatment. In this study, we revealed that NSE level of >20.98ng/mL at 48h time point can be used as an independent predictor of DNS (OR, 3.570; 95% CI, 1.412-9.026; P = .007; AUC, 0.648).

Neutrophil Lymphocyte Ratio (NLR) was Significantly Associated with Diabetic Nephropathy at Sanglah General Hospital, Denpasar, Bali, Indonesia: A Case-Control Study

Background: Diabetic nephropathy (DN) is caused by chronic complications due to microvascular changes in patients with T2DM associated with the inflammatory process. Neutrophils to Lymphocyte Ratio (NLR) is a ratio that can describe the acute and chronic inflammatory systemic and allegedly the inflammatory process in the kidney. This study aims to determine the association between NLR with diabetic nephropathy in patients with type 2 diabetes.&#x0D; Method: This study is an analytical study with a case-control design. Samples were taken from the medical record installation room at Sanglah General Hospital Denpasar. Data was taken by using a simple random sampling method for 1 year that is 2017 according to inclusion and exclusion criteria. Statistical analysis including univariate analysis, normality test, Mann Whitney test, chi-square test, and AUC was done by using SPSS 23.&#x0D; Results: 143 sample data were used in this study with an average age of 62 years old (S.D 11.5). Median NLR for DN as case group were found 3.19 ranges within 1.19-29.2 while median NLR for non-DN as control group were found 3.2 (0.82-15.5) with p=0.000. NLR proportion ≥2.5 in the non-DN group was found 30 (42.2%) and DN group were found 49 (68%) with p=0.002. Risk analysis between NLR and Diabetic nephropathy obtained OR 2.91 and 95% CI: 1.45 - 5.76. Other variables such as age, sex, and diabetic status towards NLR levels were found not statistically significant. The results of AUC were 69.6% with 95%CI within the range (61.1% -78.2%).&#x0D; Conclusion: There is a significant association between NLR and diabetic nephropathy which potentially reflects the inflammation of the diabetic nephropathy process.

POS-332 QUALITY OF LIFE IN PATIENTS WITH DIABETIC NEPHROPATHY: FINDINGS FROM THE KNOW-CKD (KOREAN COHORT STUDY FOR OUTCOME IN PATIENTS WITH CHRONIC KIDNEY DISEASE) COHORT

Diabetic nephropathy (DN) is a major cause of end-stage renal disease, and can affect quality of life (QoL) because it requires arduous lifelong management. This study analyzed QoL differences at baseline and after 5 years between DN anDiabetic nephropathy (DN) is a major cause of end-stage renal disease, and can affect quality of life (QoL) because it requires arduous lifelong management. This study analyzed QoL differences at baseline and after 5 years between DN and non-DN patients with other chronic kidney disease (CKD).d non-DN patients with other chronic kidney disease (CKD). The analysis included subjects (n=1766) from the KNOW-CKD (KoreaN cohort study for Outcome in patients With Chronic Kidney Disease) cohort who completed the Kidney Disease Quality of Life Short Form (KDQOL-SF). The factors that influenced the QoL of participants with DN (n=390) were first analyzed, and differences in QoL between DN and non-DN participants was examined. To maintain homogeneity, most factors that influenced the QoL of participants with DN were controlled by propensity score-matched pair sampling using the greedy matching technique. In total, 239 DN and 239 non-DN subjects were finally selected, and differences in the mean KDQOL-SF scores between the 2 groups were then analyzed. In the multivariate linear regression model, higher QoL scores were found for taller DN subjects and lower QoL scores were found for those who were unemployed or unmarried, received Medical Aid, had lower economic status, had higher platelet counts and alkaline phosphatase levels, and used clopidogrel or insulin. Patient satisfaction (59.9 vs. 64.5, P=0.022) and general health (35.3 vs. 39.1, P=0.041) were significantly lower in the DN group than in the non-DN group. Scores generally decreased in both groups during the 5-year follow-up, and the scores in the work status, sexual function, and role-physical domains were lower among patients with DN than among non-DN patients, but the differences were not statistically significant. In conclusion, among the DN subjects, socioeconomic factors were found to be strong risk factors for impaired QoL, as well as high platelet counts, high alkaline phosphatase levels, and clopidogrel and insulin use. The DN subjects showed lower QoL than the non-DN subjects in the domains of patient satisfaction and general health. In conclusion, we confirmed that DN itself affected QoL more strongly than other types of CKD.

Increased lipoxygenase and decreased cytochrome P450s metabolites correlated with the incidence of diabetic nephropathy: Potential role of eicosanoids from metabolomics in type 2 diabetic patients.

Diabetic nephropathy (DN) is the major cause of chronic kidney disease and end-stage renal disease. Previous studies have demonstrated that long-chain omega-3 polyunsaturated fatty acids (PUFAs) might have therapeutic potential in reducing proteinuria in DN. However, the local level of eicosanoids derived from PUFAs in the plasma of DN patients remains unclear. This work aims to study the eicosanoid profile difference in plasma of DN patients and type 2 diabetes (T2D) without DN. A total of 27 T2D patients with similar diabetic duration were recruited and divided into T2D+DN group and T2D+NDN (non-DN) group based on urinary albumin excretion (UAE) detection. Using LC-MS/MS-based metabolomics, DN patients showed increased level of lipoxygenase (LOX) metabolites (5-HETE and LTB4) and decreased levels of eicosanoids derived according to the cytochrome P450s (CYP450) metabolic pathway (5,6-DHET; 14,15-DHET and 9,10-diHOME). Receiver operating characteristics and logistic regression analysis revealed increased level LOX metabolites and decreased level of CYP450 metabolites were significantly correlated with the incidence of DN in T2D patients. LOX and CYP450 metabolites correlated with DN incidence in T2D patients, which might be treatment targets for DN in T2D patients.

The predictive value of neutrophil–lymphocyte ratio at presentation for delayed neurological sequelae in carbon monoxide poisoning

Objective To explore the predictive value of neutrophil–lymphocyte ratio (NLR) at presentation for delayed neurological sequelae (DNS) in carbon monoxide (CO) poisoning. Methods This single-center retrospective observational study included a total of 253 consecutive patients who visited the emergency department (ED) due to acute CO intoxication between 7 October 2015 and 31 December 2019. The included patients had a history of coma and their blood routine was measured within one hour of ED admission. They were divided into two groups according to the presence of DNS, including those who developed DNS (DNS group) and those who did not (non-DNS group). Results A total of 171 patients were included in this research, and 49 (28.7%) developed DNS. The median NLR at ED admission was obviously higher in the DNS group (10.60 [9.69–15.34]) than in the non-DNS group (7.53 [5.86–8.56]) (p < 0.001). Multivariate analysis indicated that a high NLR (adjusted odds ratio (AOR): 1.78, 95% confidence interval (CI): 1.46–2.18) and the occurrence of acute brain lesions (AOR: 7.50, 95%CI: 2.86–19.68) on diffusion-weighted imaging were independent predictors of DNS. The NLR was more than 8.97. The prediction of occurrence of DNS had a sensitivity of 93.88% and a specificity of 84.43%. Kappa value was 0.713. The predicted results showed good authenticity and consistency. Conclusion The level of NLR at presentation had good predictive value for the development of DNS, showing the superior value for clinical application.