Potential Marker Of Disease Severity Research Articles

Hyperkalaemia in bleeding trauma patients: A potential marker of disease severity – A retrospective cohort study

BackgroundHyperkalaemia is a common electrolyte abnormality seen in critically ill patients. In haemorrhagic shock, it may contribute to cardiac arrest and has been identified as a potential marker for tissue hypoxia. However, the significance of its role in haemorrhagic shock and its contribution to mortality remains unclear. This study aimed to examine the potential underlying pathophysiology and evaluate the incidence and characteristics of patients with hyperkalaemia on hospital arrival in bleeding trauma patients before transfusions and its mortality. MethodsA retrospective cohort study was conducted on adult patients with traumatic bleeding admitted to a European Major Trauma Centre between January 2016 and December 2021. Patients were classified according to their serum potassium levels on arrival, and relevant clinical parameters between non-hyperkalaemic and hyperkalaemic patients were compared. ResultsAmong the 83 patients in this study, 8 (9.6 %) presented with hyperkalaemia on arrival. The median shock index showed a higher tendency in the hyperkalaemic group. Hyperkalaemia was found to be more common among younger patients who sustained penetrating trauma. Mortality rates were higher in the hyperkalaemic group, but the difference was not statistically significant. ConclusionOur results suggest that hyperkalaemia occurs frequently in bleeding trauma patients on hospital arrival pre-transfusions, indicating a more severe illness. Our findings provide insights into the pathophysiology and characteristics of hyperkalaemia in bleeding trauma patients. Further studies are required to investigate the mechanisms by which hyperkalaemia contributes to mortality in haemorrhagic shock patients.

Clinicopathological and circulating cell-free DNA profile in myositis associated with anti-mitochondrial antibody.

Anti-mitochondrial antibodies (AMAs) are associated with idiopathic inflammatory myopathies (IIMs). We aimed to summarize the clinicopathological characteristics, assess circulating cell-free mitochondrial DNA (ccf-mtDNA), and circulating cell-free nuclear DNA (ccf-nDNA) in AMA-associated IIMs. Medical records of 37 IIMs patients with AMAs were reviewed. Circulating cell-free mtDNA and ccf-nDNA levels in sera from IIMs patients with AMAs (n = 21), disease controls (n = 66) and healthy controls (HCs) (n = 23) were measured and compared. Twenty-eight immune-mediated necrotizing myopathy (IMNM) patients, 23 dermatomyositis (DM) patients, and 15 anti-synthetase syndrome (ASS) patients were enrolled as disease controls. Correlations between variables were analyzed. Limb weakness was observed in 75.7% and neck weakness in 56.8% of patients. Cardiac involvement occurred in 51.4% of patients. Muscle pathology revealed 81.1% of IMNM, 5.4% polymyositis, and 13.5% nonspecific myositis. Microinfarction was observed in 8.1% of patients. Serum ccf-mtDNA levels in AMA-associated IIMs were significantly higher than those in HCs (p < 0.001), but no significant differences between AMA-associated IIMs and IMNM, DM, or ASS. Serum ccf-nDNA levels in AMA-associated IIMs were significantly higher than those in HCs (p = 0.02), and significantly lower than those in DM (p = 0.02). Serum ccf-nDNA levels correlated negatively with MMT8 total scores (rs = -0.458, p = 0.037) and positively with mRS scores (rs = 0.486, p = 0.025). Serum ccf-nDNA levels were significantly higher in the non-remission group (p < 0.01). AMA-associated IIMs exhibit distinct clinicopathological features. Serum ccf-nDNA may serve as a potential marker for disease severity and prognosis in AMA-associated IIMs.

Left atrial remodeling in hypertrophic cardiomyopathy and Fabry disease: A CMR-based head-to-head comparison and outcome analysis

BackgroundHypertrophic cardiomyopathy (HCM) and Fabry disease cardiomyopathy (FD) are phenocopies, as they show left ventricular hypertrophy (LVH). The left atrium (LA) is emerging as a potential marker of disease severity in both cardiomyopathies. The present study compares HCM and FD cardiomyopathy with similar degree of LVH, exploring LA morpho-functional parameters and the correlates of clinical outcome. MethodsWe performed a comprehensive CMR-based comparison between 30 HCM and 30 FD patients matched on age, sex, BSA, LV mass and major cardiovascular risk factors affecting LA remodeling (arterial hypertension and diabetes). 30 healthy controls were also included. CMR feature tracking (CMR-FT) analysis, T1 mapping and conventional parameters were evaluated. Patients also underwent transthoracic echocardiography for LV diastolic function assessment. Clinical events at follow-up were collected (atrial and ventricular events, bradyarrhythmia, heart failure (HF) hospitalization and death). ResultsHCM patients showed greater LA remodeling compared to FD patients, namely higher LA end-systolic volume index (LAVi max), lower LA-ejection fraction (LA-EF) and worse reservoir (εs) and booster function (εa) (all p < 0.05). Accordingly, these parameters have demonstrated good potential for distinguishing between FD and HCM (AUC 0.68–0.73, all p < 0.05), with LAVi max being an independent predictor for HCM diagnosis (OR 1.07, 95%CI 1.011–1.132, p 0.02). Moreover, in HCM patients a significant association between εs and HF occurrence was observed at 2-year follow-up (OR 0.85, 95%CI 0.72–0.99, p 0.04). ConclusionsIn HCM, LA remodeling is greater than in FD cardiomyopathy with similar LVH, and reservoir strain is associated with HF at follow-up.

Preliminary Study of sCD14 and sCD163 as Predictors of Disease Severity and ICU Admission in COVID-19: Relation to Hematological Parameters, Blood Morphological Changes and Inflammatory Biomarkers.

Research supports the role of monocyte/macrophage activation in COVID-19 immunopathology. This study aimed to evaluate sCD14 and sCD163 - the monocyte activation markers - and to investigate their relation to hematological parameters and blood morphology in COVID-19 infection. This is a case-control study that included 70 COVID-19 patients. Patients were subdivided into two groups: 23 severely diseased ICU-admitted patients and another group of 47 non-ICU-admitted patients. sCD163 and sCD14 levels were determined using ELISA. sCD163 and sCD14 showed significantly higher levels in sera of patients compared to the control group, with significantly higher levels of sCD163 in ICU-admitted patients than non-ICU admitted patients. Receiver operating characteristic curve analysis demonstrated the usefulness of sCD163 with a cut-off value of 734 ng/mL as a potential marker to discriminate between ICU and non-ICU admitted COVID-19 patients (sensitivity of 81.16%; specificity of 96.67% and positive predictive value of 98% with area under the curve of 0.930). sCD163 levels showed a positive correlation with total white blood cells, absolute neutrophilic count, Neutrophil/Lymphocyte ratio, and a negative correlation with platelet count. sCD14 levels positively correlated with D-dimer values associated with a shift to the left and neutrophilic toxic granulations in blood morphology. High sCD163 and sCD14 levels, hematological parameters, and blood morphology reflect monocyte activation in COVID-19 infection. sCD163 is a potential marker of disease severity. These findings support further study of therapeutics targeting macrophage activity in COVID-19 patients with high sCD163 levels.

The Effects of Hospitalisation on the Serum Metabolome in COVID-19 Patients.

COVID-19, a systemic multi-organ disease resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is known to result in a wide array of disease outcomes, ranging from asymptomatic to fatal. Despite persistent progress, there is a continued need for more accurate determinants of disease outcomes, including post-acute symptoms after COVID-19. In this study, we characterised the serum metabolomic changes due to hospitalisation and COVID-19 disease progression by mapping the serum metabolomic trajectories of 71 newly hospitalised moderate and severe patients in their first week after hospitalisation. These 71 patients were spread out over three hospitals in Switzerland, enabling us to meta-analyse the metabolomic trajectories and filter consistently changing metabolites. Additionally, we investigated differential metabolite-metabolite trajectories between fatal, severe, and moderate disease outcomes to find prognostic markers of disease severity. We found drastic changes in serum metabolite concentrations for 448 out of the 901 metabolites. These results included markers of hospitalisation, such as environmental exposures, dietary changes, and altered drug administration, but also possible markers of physiological functioning, including carboxyethyl-GABA and fibrinopeptides, which might be prognostic for worsening lung injury. Possible markers of disease progression included altered urea cycle metabolites and metabolites of the tricarboxylic acid (TCA) cycle, indicating a SARS-CoV-2-induced reprogramming of the host metabolism. Glycerophosphorylcholine was identified as a potential marker of disease severity. Taken together, this study describes the metabolome-wide changes due to hospitalisation and COVID-19 disease progression. Moreover, we propose a wide range of novel potential biomarkers for monitoring COVID-19 disease course, both dependent and independent of the severity.

Serum transforming growth factor-beta levels and severity of retinoblastoma in children

Background Transforming growth factor-? (TGF-?) expression contributes to the growth of retinoblastoma. TGF-? is produced or released by infiltrating cells such as lymphocytes and monocytes/macrophages. TGF-? levels are a potential marker of disease severity.&#x0D; Objective To assess the difference in serum TGF-? levels before chemotherapy in patients with retinoblastoma grades III and IV. &#x0D; Methods This cross-sectional observational study was done at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia from January to November 2019. Subjects were pediatric patients with grade III and IV retinoblastoma who had not undergone chemotherapy. Patients who met the inclusion criteria provided blood specimens for TGF-? testing. We analyzed the difference in serum TGF-? level between grade III and grade IV patients.&#x0D; Results We obtained 38 subjects, consisting of 13 grade III and 25 grade IV retinoblastoma patients. Mean TGF-? levels were in 1,061 ng/L in grade III and 988 ng/L in grade IV patients. The Mann-Whitney U test revealed no significant difference between the levels of TGF-?, retinoblastoma grade III and IV (P=0.655). However, TGF-? levels in both groups were markedly above the normal value (100 ng/L).&#x0D; Conclusion TGF-? levels are markedly increased in grade III and IV retinoblastoma patients. There was no significant difference in TGF-? level between grade III and IV patients. Our findings suggest that TGF-? plays an important role in tumor cell development. Further research on differences in TGF-? levels between late stages (grades III and IV) and early stages (grades I and II) of retinoblastoma to elucidate the role of TGF-? as a marker of retinoblastoma severity.

Sclerodermic hand: a retrospective study on the role of ultrasonography in the detection of subclinical joint involvement.

The inflammatory involvement of joints and tendons is common in Systemic Sclerosis (SSc). Ultrasonography (US) is a non-invasive tool commonly applied for the assessment of the main inflammatory arthropathies and could be also used in identifying pathological features in SSc patients, even without clinical evidence of joint complaint. So, the aim of this study was to assess the prevalence of US pathological features in a cohort of SSc patients and assessed the role of US in the detection of subclinical joint involvement. In this retrospective study, we collected data about the prevalence of US pathological features at the level of hands and wrists in a cohort of patients with a definite diagnosis of SSc,submitted to an ultrasound examination of hands and wrists according to the clinician's opinion, with or without joint involvement symptoms,in order to assess the US ability in detecting subclinical inflammatory signs in SSc patients. In total, 47.5% of patients reported at least one US pathological feature. The most common was synovial hypertrophy (62.1%). Other assessed lesions were effusion (48%), tenosynovitis (37.9%), power Doppler (PD) signal (31.0%), and erosions (0.7%). Effusion and PD signal appeared significantly higher in symptomatic patients, with a p<0.01 and p=0.045, respectively. In this cohort of SSc subjects, almost the half of the US-positive patients were clinically asymptomatic. Therefore, the application of US could be useful to detect the musculoskeletal involvement of SSc patients, a potential markers of disease severity. Further studies are required to assess the role of US in monitoring SSc patients. Key Points • The inflammatory involvement of joints and/or tendons is common in systemic sclerosis (SSc) but could be partially covered by other disease features. • Among the diagnostic methods able to increase the sensitivity of the musculoskeletal evaluation, Ultrasonography (US) is one of the most promising to reveal subclinical inflammation and predict the joint damage progression. • We retrospectively investigated the prevalence of US pathological features in a cohort of SSc patients, with or without symptoms of joint involvement, assessingthe role of US in the detection of subclinical joint involvement. • We found that joint and tendon involvement, a potential marker of disease severity, is common in SSc.

Left ventricular torsion as a prognostic marker in patients with dilated cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular (LV) torsion is the wringing motion of the ventricle around its long axis induced by contracting obliquely oriented myofibers in the LV wall and it predicts functional capacity more appropriately than LV ejection fraction (EF). Purpose This study was intended to evaluate reduced LV torsion as a potential marker of disease severity and a predictor of hospitalization for worsening heart failure in patients with non-ischemic dilated cardiomyopathy (DCM). Methods This was a single center prospective observational study wherein 127 patients with a diagnosis of non-ischemic DCM with a LVEF &amp;lt;50% were enrolled. In addition, 48 age and sex matched healthy individuals without any prior history of cardiovascular diseases and normal LVEF were enrolled as controls. All these patients underwent detailed clinical assessment including symptomatology, NYHA function class evaluation and routine blood investigations including CPK-MB levels. In addition, all enrolled subjects underwent 2D transthoracic echocardiography along with speckle tracking imaging to determine the LV global longitudinal strain (LV-GLS), LV twist and LV torsion. Based on the measurement of LV torsion, patients were stratified into two groups: preserved LV torsion (&amp;gt;0.59 degrees/cm) and reduced LV torsion (&amp;lt;0.59 degrees/cm). These patients were followed up for six months in terms of MACE events. Results Reduced LV torsion was reported in 52/127 (40.9%) patients with DCM. These patients had significantly lower LVEF, altered LV geometry (base-apical distance) and higher levels of CPK-MB. Additionally, patients with reduced LV torsion had a worsened functional class and a greater frequency of hospital admissions (34 vs 6; P&amp;lt;0.001) over 6 months of follow-up as compared to those with preserved LV torsion. Multivariate logistic regression reported reduced LV torsion to be an independent predictor of MACE events over six months of follow-up (OR:4.20; P=0.001). Conclusion Findings from our study suggested that LV torsion can serve as an additional prognostic marker in patients with non-ischemic DCM.

Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans–A potential marker for disease severity

The Coronavirus-19 disease (COVID-19) has claimed over 6.8 million lives since first being reported in late 2019. The virus that causes COVID-19 disease is highly contagious and spreads rapidly. To date, there are no approved prognostic tools that could predict why some patients develop severe or fatal disease outcomes. Early COVID-19 studies found an association between procalcitonin (PCT) and hospitalization or duration of mechanical ventilation and death but were limited by the cohort sizes. Therefore, this study was designed to confirm the associations of PCT with COVID-19 disease severity outcomes in a large cohort. For this retrospective data analysis study, 27,154 COVID-19-positive US veterans with post-infection PCT laboratory test data and their disease severity outcomes were accessed using the VA electronic healthcare data. Cox regression models were used to test the association between serum PCT levels and disease outcomes while controlling for demographics and relevant confounding variables. The models demonstrated increasing disease severity (ventilation and death) with increasing PCT levels. For PCT serum levels above 0.20 ng/ml, the unadjusted risk increased nearly 2.3-fold for mechanical ventilation (hazard ratio, HR, 2.26, 95%CI: 2.11-2.42) and in-hospital death (HR, 2.28, 95%CI: 2.16-2.41). Even when adjusted for demographics, diabetes, pneumonia, antibiotic use, white blood cell count, and serum C-reactive protein levels, the risks remained relatively high for mechanical ventilation (HR, 1.80, 95%CI: 1.67-1.94) and death (HR, 1.76, 95%CI: 1.66-1.87). These data suggest that higher PCT levels have independent associations with ventilation and in-hospital death in veterans with COVID-19 disease, validating previous findings. The data suggested that serum PCT level may be a promising prognostic tool for COVID-19 severity assessment and should be further evaluated in a prospective clinical trial.

Split-elbow sign in the PRO-ACT and Southern Italy ALS cohorts: a potential marker of disease severity and lower motor neuron involvement?

Split phenomena in ALS refers to the preferential dysfunction of some groups of muscles over others. The split-elbow sign (SE) is characterized by the predominant weakness of the biceps compared to the triceps, but available results are conflicting. To evaluate the prevalence of the SE in two independent cohorts: the randomized controlled trial-based PRO-ACT cohort (n = 500) and a monocentric cohort of patients with ALS from Southern Italy (n = 144); to investigate the demographic and clinical variables associated with the SE sign. Wilcoxon signed-rank test was used to compare biceps with triceps power in the same limb measured by hand-held dynamometry in the PRO-ACT cohort and Medical Research Council (MRC) in our cohort. Each limb was considered independently and not paired within the same individual. The arm where the triceps was stronger than the biceps was defined SE + , whereas the arm where the biceps was stronger than the triceps was considered SE-. A backward stepwise multivariate logistic regression was used to analyze the relationship between clinical and demographic variables and SE. PENN Upper Motor Neuron and Devine scales were used to evaluate the different upper (UMN) and lower (LMN) motor neuron impairments between the SE + and SE- arms. In both cohorts, the biceps were on average stronger than the triceps, and the SE sign was present in 41% of the PRO-ACT cohort and just 30% of the Southern Italy cohort. The multivariate logistic regression revealed that older age (OR: 1.45; p = 0.01), male gender (OR: 1.55; p = 0.002), spinal onset (OR: 1.59; p = 0.007), and higher disease severity (OR: 1.70; p = 0.001) were significant predictors of the SE sign in the PRO-ACT cohort. Conversely, in Southern Italy patients, only a lower ALSFRS-R score was a significant determinant of the SE (OR: 8.47; p = 0.008). Finally, SE + arms exhibited a significantly higher median Devine sub-score compared to SE- [1 vs 0, p = < 0.05], while arms SE- showed a significantly higher median PUMNS sub-score [2 vs 0; p = < 0.05)]. In our study, most patients with ALS do not show SE. Patients with SE are more likely older, males, with spinal onset, a higher degree of disease severity, and predominant and wider LMN impairment.

Polymorphisms within Genes Coding for IL-17A and F and Their Receptor as Clinical Hallmarks in Ankylosing Spondylitis.

IL-17A and IL-17F together with their coreceptor (IL-17RA/RC) were reported to play a significant role in the pathogenesis of spondyloarthritis. The group of axial spondyloarthritis comprises ankylosing spondylitis (AS), a rheumatic disease characterized by chronic inflammation of the joints in the spine. This study is aimed at investigating IL-17A, IL-17F, IL-17RA, and IL-17RC polymorphisms as potential biomarkers of disease susceptibility, clinical parameters, and anti-TNF treatment outcome in a cohort of Polish ankylosing spondylitis patients. In total, 328 subjects, including 138 AS patients and 190 healthy volunteers, participated in the study. Genotyping of IL-17A rs2275913 (G/A), IL-17F rs763780 (A/G), IL-17RA rs4819554 (A/G), and IL-17RC rs708567 (G/A) was performed on real-time PCR instrument using LightSNiP assays. No significant differences were revealed in genotype and allele distribution between patients and controls despite the association of the IL-17RC rs708567 AA homozygosity with the earlier onset of the disease. Moreover, some relationships between IL-17F rs763780 and IL-17RA rs4819554 polymorphisms with clinical parameters related to the disease activity and anti-TNF treatment outcome were observed. IL-17F rs763780 G allele was found to be associated with high disease activity and BASDAI after 6 months and poor response to the treatment while higher VAS values were more common among IL-17RA rs4819554 G variant carriers. In conclusion, the IL-17F rs763780 polymorphism should be considered as a promising biomarker of disease activity and anti-TNF treatment outcome. The IL-17RA rs48419554 G allele may serve as a potential marker of disease severity in Polish AS patients.

Sick Euthyroid Syndrome on Presentation of Patients With COVID-19: A Potential Marker for Disease Severity

ObjectivePrecise risk stratification and triage of coronavirus disease 2019 (COVID-19) patients are essential in the setting of an overwhelming pandemic burden. Clinical observation has shown a somewhat high prevalence of sick euthyroid syndrome among patients with COVID-19. This study aimed to evaluate the predictive value of free triiodothyronine (FT3) at the clinical presentation of COVID-19 for disease severity and death. MethodsThis retrospective cohort study was based on electronic medical records. The study was conducted at Sheba Medical Centre, a tertiary hospital where several acute and chronic wards have been dedicated to the treatment of patients with COVID-19. The primary outcome measure was death during hospitalization; secondary outcomes included hospitalization in intensive care, mechanical ventilation, and length of hospitalization. ResultsOf a total of 577 polymerase chain reaction-positive patients with COVID-19 hospitalized between February 27 and July 30, 2020, 90 had at least 1 measurement of thyroid-stimulating hormone, free thyroxine, and FT3 within 3 days of presentation. After applying strict exclusion criteria, 54 patients were included in the study. Patients in the lowest tertile of FT3 had significantly higher rates of mortality (40%, 5.9%, and 5.9%, P = .008), mechanical ventilation (45%, 29.4%, and 0.0%; P = .007) and intensive care unit admission (55%, 29.4%, and 5.9%, P = .006). In multivariate analyses adjusted for age, Charlson comorbidity index, creatinine, albumin, and white blood cell count. FT3 remained a significant independent predictor of death. ConclusionFT3 levels can serve as a prognostic tool for disease severity in the early presentation of COVID-19.

Serum progranulin levels in paediatric patients with Gaucher disease; relation to disease severity and liver stiffness by transient elastography.

Non-invasive screening for liver fibrosis using transient elastography (TE) could be of value in the management of Gaucher disease (GD). Progranulin (PGRN) is a novel disease modifier in GD and an independent marker of liver fibrosis. We determined PGRN levels in paediatric patients with GD and assessed its role as a potential marker for disease severity and relation to liver stiffness by TE. Fifty-one GD patients (20 had type 1 and 31 had type 3) with a median age of 9.5years were compared to 40 age- and sex-matched healthy controls and were studied focusing on visceral manifestations, neurological disease, haematological profile and PGRN levels as well as abdominal ultrasound and TE. Patients were on enzyme replacement therapy (ERT) for various durations and those with viral hepatitis infection were excluded. By TE, 14 GD patients (27.5%) had elevated liver stiffness ≥7.0kPa. Liver stiffness was significantly higher in type 1 GD patients than type 3 (P=.002), in splenectomized patients (P=.012) and those with dysphagia (P<.001). Liver stiffness was positively correlated with age of onset of ERT (P<.001). PGRN levels were significantly lower in GD patients compared with controls (P<.001). PGRN was significantly lower in GD patients with squint (P=.025), dysphagia (P=.036) and elevated liver stiffness (P=.015). PGRN was positively correlated with white blood cell count (r=.455, P=.002) and haemoglobin (r=.546, P<.001), while negatively correlated with severity score index (r=-.529, P<.001), liver volume (r=-.298, P=.034) and liver stiffness (r=-.652, P<.001). Serum PGRN levels were associated with clinical disease severity and elevated liver stiffness in paediatric GD patients.

Acute Dilation of Venous Sinuses in Animal Models of Mild Traumatic Brain Injury Detected Using 9.4T MRI.

Mild traumatic brain injury (mTBI) is a debilitating but extremely common form of brain injury that affects a substantial number of people each year. mTBI is especially common in children and adolescents. Our understanding of mTBI pathophysiology is limited, and there is currently no accepted marker for disease severity. A potential marker for disease severity may be cerebrovascular dysfunction. Recent findings have implicated cerebrovascular alteration as an important component of mTBI and suggest it contributes to the development of persistent, long-term symptoms. In this paper, we conducted two studies to investigate whether mTBI affects venous drainage patterns in the central nervous system using alterations in the size of venous sinuses as a marker of changes in drainage. Using a closed head vertical weight-drop model and a lateral impact injury model of mTBI, we imaged and quantified the size of three major draining vessels in the adolescent rat brain using 9.4T MRI. Areas and volumes were quantified in the superior sagittal sinus and left and right transverse sinuses using images acquired from T2w MRI in one study and post-gadolinium T1w MRI in another. Our results indicated that the three venous sinuses were significantly larger in mTBI rats as compared to sham rats 1-day post injury but recovered to normal size 2 weeks after. Acutely enlarged sinuses post-mTBI may indicate abnormal venous drainage, and this could be suggestive of a cerebrovascular response to trauma.

Evaluation of ADA activity as a potential marker of disease severity in psoriasis patients.

BackgroundPsoriasis is a dermatological disorder with a multifactorial origin and is associated with many biochemical and immunological changes.PurposeThis study aimed to examine the association of serum ADA activity, uric acid (UA), and high-sensitivity CRP (hs-CRP) with psoriasis and the role of ADA in disease severity.Materials and methodsIn this comparative cross-sectional study, 50 clinically and histopathologically diagnosed psoriasis patients and 50 age- and sex-matched healthy controls were enrolled. Blood samples were taken and analysis of the biochemical parameters was performed according to Giuisti and Galanti method, uricase and ELISA technique for ADA activity, UA, and hs-CRP, respectively. The severity of the disease was scored according to Psoriasis Area and Severity Index (PASI). Statistical analysis of differences within and between the study groups was carried out using the Student’s t-test, one-way post hoc ANOVA, and Pearson’s correlation. Linear regression was used to establish the independent association of ADA with disease severity.ResultsThe serum ADA activity, UA, and hs-CRP levels of the psoriatic patients were found to be significantly higher (P<0.001). hs-CRP was positively correlated with ADA and UA in patients (P<0.001). There was no significant difference in total cholesterol, low-density lipoprotein, and triacylglycerol in psoriasis patients, whereas we noted a decreased high-density lipoprotein level in psoriasis patients as compared to controls. Linear regression showed that ADA was independently associated with the disease severity and was statistically significant (P<0.001).ConclusionADA activity was positively and significantly associated with the severity of psoriasis, therefore, it could be suggested as a marker for disease severity in psoriasis patients.

Parathyroid hormone serum concentration in Central European patients with non-ischaemic heart failure as a potential marker of disease severity and poor prognosis.

Parathyroid hormone (PTH) might be considered as a potential marker of disease severity and worse prognosis in heart failure (HF) patients. The aim of the study was to assess PTH, vitamin D, phosphorus (P), and total calcium (Ca2+) serum concentrations in Central European patients suffering from HF of non-ischaemic origin compared to non-HF volunteers.To evaluate potential correlations among the enumerated parameters, established markers of worse prognosis and declared sun exposure. Serum intact-PTH, 25-OH vitamin D, P, and total Ca2+ concentrations were assessed in a group of HF patients and non-HF volunteers. Patients described their daily profile of sun exposure during the previous eight weeks as "above" or "below" seven hours a week. The mean PTH concentrations in the non-ischaemic HF group and control group were 79.5 pg/mL and 59.6 pg/mL, respectively (P = 0.009). Non-HF volunteers declaring higher sun exposure time had higher serum concentrations of vitamin D compared to those with lower sun exposure time (30.3 vs. 23.8 ng/mL, P < 0.05), unlike the HF patients (24.1 ng/mL vs. 23.2 ng/mL, P = ns). Multiple regression analysis revealed the relationship between age, NT-proBNP (N-terminal pro-brain natriuretic peptide), P, and PTH as a dependent variable. PTH is significantly elevated in non-ischaemic HF patients compared to non-HF volunteers and correlates with established factors of worse prognosis, including age, estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST), serum concentrations of creatinine, and NT-proBNP. Declared sun exposure did not affect the serum concentration of vitamin D in the HF group, in contrast to the control group.

Neither too much, neither too little! Positive fluid balance and ICU outcome

The fluid balance of critically ill patients has emerged as a potential marker of disease severity. This is associated with worse outcome and prolonged time of use of intensive care support in the ICU.

Association of plasma levels of Protein S with disease severity in multiple sclerosis

BackgroundThe TAM family of receptor tyrosine kinases (TYRO3, AXL and MERTK) play important roles in modulating innate immune responses and central demyelination. The TAM receptor ligand Protein S (PROS) has also been shown to modulate innate immune cell responses.ObjectivesWe assessed whether plasma levels of PROS are changed in multiple sclerosis (MS) patients and whether changes are associated with disease severity.MethodsPlasma levels of total and free PROS were measured using enzyme-linked immunosorbent assay in a discovery cohort (MS: 65, control: 14) and an independent replication cohort (MS: 29, control: 29). The Multiple Sclerosis Severity Score (MSSS) was used to evaluate associations between plasma PROS levels and disease severity.ResultsWe found plasma levels of total, but not free PROS, were decreased in MS patients compared with controls. In female MS patients, we observed decreases in total and free PROS levels compared with controls. In addition, we also observed higher MSSS in patients with very low levels of plasma free PROS.ConclusionsThese data suggest PROS may represent a potential marker of disease severity in MS.

Elevated salivary protein in Parkinson's disease and salivary DJ-1 as a potential marker of disease severity.

There is an urgent need to identify robust biomarkers for Parkinson's disease (PD). Previous studies have shown changes in composition and secretion of saliva in patients with PD, including an increase in salivary DJ-1 concentration. Autonomic dysfunction is a known feature of PD and could contribute to abnormal salivary gland function. In this pilot cross-sectional study, characterisation of the saliva of 16 patients with PD and 22 age-matched controls was performed. Salivary DJ-1 concentration was measured with quantitative immunoblotting; total protein concentration with a BCA assay and spectrophotometry; amylase with an amylase activity assay; albumin with an ELISA and mucin concentration with periodic-acid Schiff staining of SDS-gels. Patient saliva showed an increase in both total protein concentration (8.4 vs 5.0 mg/ml, p = 0.0002) and DJ-1 concentration (0.84 vs 0.42 μg/ml, p = 0.001), but there was no difference in salivary DJ-1 after adjusting for total protein concentration. In patients, adjusted DJ-1 levels correlated with disease severity measured with the MDS-Unified Parkinson's Disease Rating Scale (p = 0.019). Patient saliva had elevated concentrations of amylase (127 vs 64 units/ml, p = 0.0005) and albumin (110 vs 47μg/ml, p = 0.0003) but not mucins. This study suggests that the saliva of patients with PD is different in composition to that of healthy age-matched controls, supporting the notion that saliva may be a good candidate for biomarker discovery in PD. The specific differences suggest that major salivary glands and gingival crevicular fluid may both be sources of additional DJ-1 and protein in patient saliva.

Hyperuricemia and Proteinuria in Type 2 Diabetic Patients

Background : Type 2 diabetes mellitus is a metabolic disorder that has diabetic nephropathy as a complication characterized by proteinuria. When type 2 diabetic patient’s kidney is damaged, hyperuricemia occurs. This study evaluated the correlation of serum uric acid and proteinuria levels in type 2 diabetic patients from outpatient Endocrine clinic at Dr. Hasan Sadikin General Hospital from January to December 2011. Methods : In a cross-sectional study of 125 patients (55 male and 70 female) with type 2 diabetes mellitus, the data of serum uric acid, fasting plasma glucose, 2-h post oral glucose load plasma glucose, serum high-density lipoprotein cholesterol, serum trygliceride, and proteinuria levels were accessed from the medical record. Spearman test was used to calculate the correlation of serum uric acid and proteinuria levels. The research used secondary data taken from medical records of patients diagnosed with T2DM from outpatient Endocrine clinic of Internal Medicine Department at Dr. Hasan Sadikin General Hospital Bandung who had alaboratory examination at Department of Clinical Pathology of Dr. Hasan Sadikin General Hospital Bandung from January to December 2011. Results : The mean age of the type 2 diabetic patients was 61.5±9.2 years old, with mean serum uric acid level of 6.2±1,8 mg/dl, of whom 52.8% had microalbuminuric and 4.8% had proteinuria. In type 2 diabetic patients, serum uric acid level correlated positively (r=0.273) with proteinuria (p=0.002). Conclusions : Higher serum uric acid levels associated significantly positive with a greater probability of proteinuria in type 2 diabetic patients, indicating a potential marker for disease severity. Keywords : Proteinuria, type 2 diabetes mellitus, uric acid DOI : 10.15850/amj.v2n1.430