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Over-expression of KRT17 and MDK genes at mRNA levels in urine-exfoliated cells is associated with early non-invasive diagnosis of non-muscle-invasive bladder cancer 尿液脱落细胞中 KRT17 和 MDK 基因 mRNA 水平的过度表达与非肌层浸润性膀胱癌的早期非侵入性诊断有关。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-26 DOI: 10.1016/j.clinbiochem.2024.110808
Parisa Dayati , Nasser Shakhssalim , Abdolamir Allameh

Introduction

Current diagnostic approaches for bladder cancer (BLCA) are often invasive or lack the required sensitivity and specificity. This underscores the need for an early non-invasive diagnostic test for BLCA. This work aimed to explore the potential of molecular markers in urine-exfoliated cells for the diagnosis of non-muscle-invasive bladder cancer (NMIBC).

Materials and methods

Urine specimens (n = 140) were collected from NMIBC patients (n = 68) and control subjects (31 healthy volunteers and 41 non-cancer patients with common urological diseases [CUD]. Total RNA was extracted from the cells isolated from urine specimens. mRNA expression of selected genes: CDC20, KRT15, FOXM1, CXCR2, UPK1B, MDK, KRT20, and KRT17 was determined using RT-qPCR. The receiver operating characteristic (ROC) curve was then plotted to obtain the area under the curve (AUC), specificity, and sensitivity of the urinary mRNA markers.

Results

The expression of CDC20, MDK, UPK1B, FOXM1, KRT17, and KRT20 was up-regulated in samples obtained from low- and high-grade pathological grades of NMIBC compared to that measured in healthy subjects. Notably, MDK and KRT17 mRNA levels in the low- and high-grade cases were substantially higher than in normal and CUD groups. The AUC of the KRT17 and MDK combination in diagnosing NMIBC was 0.92, surpassing that of single genes. The sensitivity and specificity of the KRT17 and MDK combination were 74% and 94%, respectively. In diagnosing low-grade from healthy and CUD groups, analysis of the KRT17 and MDK combination yielded AUCs of 0.94 and 0.95, respectively, with sensitivities of 85% and 97%, and specificities of 93% and 85%.

Conclusion

The findings of this study revealed that KRT17 and MDK together are potential urine-based biomarkers for early diagnosis of NMIBC.

导言:目前诊断膀胱癌(BLCA)的方法通常都是侵入性的,或者缺乏所需的灵敏度和特异性。这凸显了对膀胱癌早期非侵入性诊断测试的需求。这项工作旨在探索尿液脱落细胞中分子标记物诊断非肌层浸润性膀胱癌(NMIBC)的潜力:收集非肌层浸润性膀胱癌患者(68 人)和对照组(31 名健康志愿者和 41 名患有常见泌尿系统疾病的非癌症患者 [CUD])的尿液标本(140 人)。从尿液标本中分离的细胞中提取总 RNA:采用 RT-qPCR 测定 CDC20、KRT15、FOXM1、CXCR2、UPK1B、MDK、KRT20 和 KRT17 等选定基因的 mRNA 表达。然后绘制接收者操作特征曲线(ROC),得出尿液 mRNA 标记的曲线下面积(AUC)、特异性和灵敏度:结果:与健康人相比,低度和高度病理性NMIBC样本中CDC20、MDK、UPK1B、FOXM1、KRT17和KRT20的表达上调。值得注意的是,低级别和高级别病例中的 MDK 和 KRT17 mRNA 水平大大高于正常组和 CUD 组。KRT17 和 MDK 组合诊断 NMIBC 的 AUC 为 0.92,超过了单个基因。KRT17和MDK组合的灵敏度和特异度分别为74%和94%。在从健康组和 CUD 组诊断低级别时,对 KRT17 和 MDK 组合的分析得出的 AUC 分别为 0.94 和 0.95,敏感性分别为 85% 和 97%,特异性分别为 93% 和 85%:本研究结果表明,KRT17和MDK组合是早期诊断NMIBC的潜在尿液生物标记物。
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引用次数: 0
Serum lactate/creatinine ratio and acute kidney injury in cardiac arrest patients 心脏骤停患者的血清乳酸/肌酐比率和急性肾损伤。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-26 DOI: 10.1016/j.clinbiochem.2024.110806
Liangen Lin , Congcong Sun , Yuequn Xie , Yuanwen Ye , Peng Zhu , Keyue Pan , Linglong Chen

Objectives

Serum lactate and creatinine levels upon admission in cardiac arrest (CA) patients significantly correlate with acute kidney injury (AKI) post-restoration of autonomic circulation. However, the association between serum lactate/creatinine ratio (LCR) and AKI in this population remains unclear. This study aimed to explore the relationship between LCR at admission and cardiac arrest-associated acute kidney injury (CA-AKI).

Design and methods

We conducted a secondary analysis of previously published data on CA patient resuscitation, categorizing them into tertiles based on LCR levels. Univariate and multivariate logistic regression models and subgroup analyses were employed to investigate the association between LCR and CA-AKI. Non-linear correlations were explored using restricted cubic splines, and a two-piece wise logistic proportional hazards model for both sides of the inflection point was constructed.

Results

A total of 374 patients (72.19 % male) were included, with intensive care unit mortality, in-hospital mortality, and neurologic dysfunction rates of 51.87 %, 56.95 %, and 39.57 %, respectively. The overall CA-AKI incidence was 59.09 %. Multivariate logistic proportional hazards analysis revealed a negative association between LCR and CA-AKI incidence (adjusted odds ratio [OR] 0.85, 95 % confidence intervals [CI] = 0.78–0.93, P=0.001). Triple spline restriction analysis depicted an L-shaped correlation between baseline LCR and CA-AKI incidence. Particularly, a baseline LCR<0.051 was negatively associated with CA-AKI incidence (OR 0.494, 95 % CI=0.319–0.764, P=0.002). Beyond the LCR turning point, estimated dose–response curves remained consistent with a horizontal line.

Conclusions

Baseline LCR in CA patients exhibits an L-shaped correlation with AKI incidence following restoration of autonomic circulation. The threshold for CA-AKI is 0.051. This finding suggests that LCR may aid in identifying CA patients at high risk of AKI.

目的:心脏骤停(CA)患者入院时的血清乳酸和肌酐水平与自主循环恢复后的急性肾损伤(AKI)密切相关。然而,该人群的血清乳酸/肌酐比值(LCR)与急性肾损伤之间的关系仍不清楚。本研究旨在探讨入院时乳酸/肌酐比值与心脏骤停相关急性肾损伤(CA-AKI)之间的关系:我们对之前发表的 CA 患者复苏数据进行了二次分析,根据 LCR 水平将其分为三等分。采用单变量和多变量逻辑回归模型以及亚组分析来研究 LCR 与 CA-AKI 之间的关系。使用限制性立方样条探索了非线性相关性,并构建了拐点两侧的双片式逻辑比例危险模型:共纳入 374 名患者(72.19% 为男性),重症监护室死亡率、院内死亡率和神经功能障碍发生率分别为 51.87%、56.95% 和 39.57%。CA-AKI 总发生率为 59.09%。多变量逻辑比例危险度分析显示,LCR与CA-AKI发生率呈负相关(调整后赔率比[OR] 0.85,95%置信区间[CI] = 0.78-0.93,P=0.001)。三重样条限制分析显示,基线 LCR 与 CA-AKI 发生率呈 L 型相关。尤其是基线 LCR:CA 患者的基线 LCR 与恢复自主循环后的 AKI 发生率呈 L 型相关。CA-AKI的阈值为0.051。这一发现表明,LCR 可能有助于识别 AKI 高风险 CA 患者。
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引用次数: 0
Long term false positive hsTnI on Alinity I probably caused by macrotroponin complex: Case report 可能由巨凝乳蛋白复合物引起的阿利特I长期假阳性hsTnI:病例报告。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-24 DOI: 10.1016/j.clinbiochem.2024.110802
Tamara Sušić , Marijana Miler , Nora Nikolac Gabaj , Andrea Tešija Kuna , Krešimir Kordić , Vedrana Ilić , Ozren Vinter

Elevated troponin levels are often indicative of various cardiac diseases; however, analytical interference can lead to false positive troponin concentrations. We present the case of a 48-year-old female patient with persistently falsely elevated high sensitivity troponin I (hsTnI) probably caused by the presence of macrotroponin. Laboratory testing included determination of hsTnI using various analytical methods, serial dilutions and determination of heterophilic antibodies and other autoimmune antibodies. Only precipitation with polyethylene glycol (PEG) indicated the presence of an interference by causing a significant decrease in hsTnI concentration.

Our results suggest that the falsely elevated hsTnI concentration could be due to interference with the macrotroponin complex.

肌钙蛋白水平升高通常是各种心脏疾病的征兆;然而,分析干扰可导致肌钙蛋白浓度假阳性。我们介绍了一例 48 岁女性患者的病例,她的高敏肌钙蛋白 I(hsTnI)持续假性升高,可能是由大肌钙蛋白的存在引起的。实验室检测包括使用各种分析方法测定 hsTnI、连续稀释以及测定嗜异性抗体和其他自身免疫抗体。只有聚乙二醇(PEG)沉淀才会导致 hsTnI 浓度显著下降,从而表明存在干扰。我们的结果表明,hsTnI 浓度的假性升高可能是由于大促红细胞生成素复合物的干扰所致。
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引用次数: 0
Utility of fractional excretion of magnesium in diagnosing renal magnesium wasting in pediatric nephrology practice 在儿科肾病学实践中,镁的分数排泄量在诊断肾性镁耗竭中的实用性。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-24 DOI: 10.1016/j.clinbiochem.2024.110807
Midori Awazu, Kazuya Matsumura

Background

Fractional excretion of magnesium (FEMg) is commonly used to diagnose of renal magnesium (Mg) wasting, but it can be affected by serum Mg (SMg) and serum creatinine concentration (SCr). We investigated the sensitivity and specificity of FEMg to diagnose Mg wasting in subgroups with different SMg and eGFR (estimated glomerular filtration rate) in pediatric nephrology practice.

Methods

One hundred and nineteen patients (59 males and 60 females, median 15 years) seen in our pediatric clinic were investigated for FEMg, SMg, eGFR, and urine Mg-to-creatinine ratio (Mg/Cr). Normal eGFR was defined as ≥ 90 ml/min/1.73 m2 or for infants SCr < chronic kidney disease stage 2. Urine Mg/Cr was compared with age-specific reference values.

Results

Sixteen of all patients (13 %) had hypomagnesemia. All had FEMg greater than the cut-off value of 2 %. Only 4 patients had elevated urine Mg/Cr. Of 65 patients with normal SMg and eGFR, 19 had FEMg above the cut-off value of 4 %. Of these, 13 patients had elevated urine Mg/Cr i.e. Mg wasting (sensitivity and specificity of FEMg, 93 % and 88 %, respectively). Among 38 patients with normal SMg and low eGFR, 30 had FEMg > 4 %, but only 6 had elevated urine Mg/Cr (sensitivity 100 % and specificity 25 %). Overall, hypomagnesemic patients and normomagnesemic patients with elevated urine Mg/Cr were diagnosed with Mg wasting (36/119, 30 %).

Conclusions

FEMg has variable sensitivity and specificity depending on SMg and eGFR in the diagnosis of Mg wasting. Mg wasting is not uncommon in pediatric nephrology practice.

背景:镁的分数排泄量(FEMg)通常用于诊断肾性镁(Mg)消耗,但它会受到血清镁(SMg)和血清肌酐浓度(SCr)的影响。我们研究了在儿科肾脏病实践中,FEMg 在不同 SMg 和 eGFR(估计肾小球滤过率)亚群中诊断镁消耗的敏感性和特异性:在儿科门诊就诊的 119 名患者(59 名男性,60 名女性,中位数 15 岁)接受了 FEMg、SMg、eGFR 和尿镁肌酐比(Mg/Cr)的检查。正常 eGFR 的定义是≥ 90 ml/min/1.73 m2 或婴儿 SCr 结果:所有患者中有 16 人(13%)患有低镁血症。所有患者的血镁均高于 2% 的临界值。只有 4 名患者尿镁/钙升高。在 65 名 SMg 和 eGFR 正常的患者中,19 名患者的 FEMg 超过了 4% 的临界值。其中,13 名患者的尿液 Mg/Cr 升高,即镁消耗(FEMg 的敏感性和特异性分别为 93% 和 88%)。在 38 名 SMg 正常且 eGFR 低的患者中,有 30 人的 FEMg > 4%,但只有 6 人的尿 Mg/Cr 升高(灵敏度为 100%,特异性为 25%)。总体而言,尿镁/铬升高的低镁血症患者和正常镁血症患者被诊断为镁消耗(36/119,30%):FEMg在诊断镁消耗方面具有不同的敏感性和特异性,具体取决于SMg和eGFR。镁消耗在儿科肾病中并不少见。
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引用次数: 0
Clinical laboratory test utilization of CSF oligoclonal bands and IgG index in a tertiary pediatric hospital 一家三级儿科医院对脑脊液寡克隆带和 IgG 指数的临床实验室检测使用情况。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-23 DOI: 10.1016/j.clinbiochem.2024.110803
Rachel K. Vanderschelden , Nicholas L. Benjamin , Michael R. Shurin , Levi Shelton , Sarah E. Wheeler

Background

Criteria developed for the diagnosis of multiple sclerosis (MS) in adults are also used in the pediatric setting. However, differential diagnosis in pediatric-onset MS (POMS) is distinct from that of adult-onset MS. There is little literature characterizing the utility of oligoclonal bands (OCB) and IgG index in differentiating POMS from other childhood diseases with overlapping clinical presentation which can require immediate treatment.

Methods

A retrospective review of all MS panels resulted between March 2022 and May 2023 on patients age ≤ 18 years at one tertiary care pediatric hospital in the northeastern United States was performed with pediatric neurology collaboration to characterize clinical utility (n = 85 cases).

Results

Demyelinating diseases accounted for 31 of 85 total cases (36.5%), 12 of these cases were POMS (14%). Other diagnoses consisted of psychiatric etiologies (17.6%), infectious meningitis/encephalitis (5.9%), and migraine (5.9%). Elevated IgG index was seen in 67% of those with demyelinating diseases, versus only 13% of those with other conditions. Unique OCBs were found in 41% of those with demyelinating diseases, versus only 9% of those with other conditions. Fourteen of 15 patients (93.3%) with psychiatric conditions had normal MS panels.

Conclusions

Patients with demyelinating diseases were more likely to have elevated IgG index and unique OCBs versus patients with other conditions. For pediatric hospitals without in-house OCB evaluation, implementation of an in-house IgG index may serve as a rapid screen for differentials that include demyelinating diseases while awaiting OCB results, in the appropriate clinical context.

Impact statement

IgG index and CSF oligoclonal bands are important tools in the diagnosis of patients with suspected Multiple Sclerosis (MS). In the pediatric population, these markers are used to differentiate pediatric-onset MS (POMS) from other neurologic, psychiatric, and inflammatory diseases that display clinical overlap. The use of these markers in differentiating these conditions has not been thoroughly investigated. We examined the associations between abnormal markers and final diagnoses in pediatric patients undergoing testing for POMS in order to identify trends that may enhance ordering and reporting practices.

背景:成人多发性硬化症(MS)的诊断标准也适用于儿科。然而,儿科多发性硬化症(POMS)的鉴别诊断与成人多发性硬化症截然不同。关于寡克隆带(OCB)和 IgG 指数在区分 POMS 与其他临床表现重叠、需要立即治疗的儿童疾病方面的作用的文献很少:方法:美国东北部一家三级儿科医院与儿科神经内科合作,对2022年3月至2023年5月期间18岁以下患者的所有MS检查结果进行了回顾性审查,以确定临床效用(n = 85例):结果:在85例病例中,脱髓鞘疾病占31例(36.5%),其中12例为POMS(14%)。其他诊断包括精神病因(17.6%)、感染性脑膜炎/脑炎(5.9%)和偏头痛(5.9%)。67%的脱髓鞘疾病患者的IgG指数升高,而其他疾病患者的IgG指数仅为13%。脱髓鞘疾病患者中有 41% 发现了独特的 OCB,而其他疾病患者中仅有 9%。15名精神疾病患者中有14人(93.3%)的MS面板正常:结论:与其他疾病患者相比,脱髓鞘疾病患者更容易出现IgG指数升高和OCB阳性。对于没有内部OCB评估的儿科医院来说,在适当的临床环境下,实施内部IgG指数可作为包括脱髓鞘疾病在内的鉴别诊断的快速筛查,同时等待OCB结果:IgG 指数和脑脊液寡克隆带是诊断疑似多发性硬化症(MS)患者的重要工具。在儿科人群中,这些标记物用于区分儿科多发性硬化症(POMS)与其他临床重叠的神经、精神和炎症性疾病。这些标记物在区分这些疾病方面的应用尚未得到深入研究。我们研究了接受 POMS 检测的儿科患者的异常标记物与最终诊断之间的关联,以确定可改进下单和报告实践的趋势。
{"title":"Clinical laboratory test utilization of CSF oligoclonal bands and IgG index in a tertiary pediatric hospital","authors":"Rachel K. Vanderschelden ,&nbsp;Nicholas L. Benjamin ,&nbsp;Michael R. Shurin ,&nbsp;Levi Shelton ,&nbsp;Sarah E. Wheeler","doi":"10.1016/j.clinbiochem.2024.110803","DOIUrl":"10.1016/j.clinbiochem.2024.110803","url":null,"abstract":"<div><h3>Background</h3><p>Criteria developed for the diagnosis of multiple sclerosis (MS) in adults are also used in the pediatric setting. However, differential diagnosis in pediatric-onset MS (POMS) is distinct from that of adult-onset MS. There is little literature characterizing the utility of oligoclonal bands (OCB) and IgG index in differentiating POMS from other childhood diseases with overlapping clinical presentation which can require immediate treatment.</p></div><div><h3>Methods</h3><p>A retrospective review of all MS panels resulted between March 2022 and May 2023 on patients age ≤ 18 years at one tertiary care pediatric hospital in the northeastern United States was performed with pediatric neurology collaboration to characterize clinical utility (n = 85 cases).</p></div><div><h3>Results</h3><p>Demyelinating diseases accounted for 31 of 85 total cases (36.5%), 12 of these cases were POMS (14%). Other diagnoses consisted of psychiatric etiologies (17.6%), infectious meningitis/encephalitis (5.9%), and migraine (5.9%). Elevated IgG index was seen in 67% of those with demyelinating diseases, versus only 13% of those with other conditions. Unique OCBs were found in 41% of those with demyelinating diseases, versus only 9% of those with other conditions. Fourteen of 15 patients (93.3%) with psychiatric conditions had normal MS panels.</p></div><div><h3>Conclusions</h3><p>Patients with demyelinating diseases were more likely to have elevated IgG index and unique OCBs versus patients with other conditions. For pediatric hospitals without in-house OCB evaluation, implementation of an in-house IgG index may serve as a rapid screen for differentials that include demyelinating diseases while awaiting OCB results, in the appropriate clinical context.</p></div><div><h3>Impact statement</h3><p>IgG index and CSF oligoclonal bands are important tools in the diagnosis of patients with suspected Multiple Sclerosis (MS). In the pediatric population, these markers are used to differentiate pediatric-onset MS (POMS) from other neurologic, psychiatric, and inflammatory diseases that display clinical overlap. The use of these markers in differentiating these conditions has not been thoroughly investigated. We examined the associations between abnormal markers and final diagnoses in pediatric patients undergoing testing for POMS in order to identify trends that may enhance ordering and reporting practices.</p></div>","PeriodicalId":10172,"journal":{"name":"Clinical biochemistry","volume":"131 ","pages":"Article 110803"},"PeriodicalIF":2.5,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0009912024000973/pdfft?md5=e1642a4f678b4f5481b5a575c36e4fb8&pid=1-s2.0-S0009912024000973-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Discrepancy between estimated glomerular filtration rate by creatinine versus cystatin C in different patient care settings 在不同的患者护理环境中,用肌酐估算的肾小球滤过率与用胱抑素 C 估算的肾小球滤过率之间存在差异。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-17 DOI: 10.1016/j.clinbiochem.2024.110801
Li Liu, Daniel Y. Chang, Kent B. Lewandrowski, Anand S. Dighe

Objective

Estimated glomerular filtration rate (eGFR) calculated by cystatin C (cysC) has been recommended for broader adoption. This study assessed the discrepancy between eGFR calculated by cysC (eGFRcys) and creatinine (eGFRcr) in different patient care settings and explored potential contributing factors to such discrepancies.

Methods

This retrospective study included 2072 patients with paired cysC and creatinine results in different patient care settings. Delta eGFRcr-cys (eGFRcr − eGFRcys) was analyzed in relationship to patient care settings and the Elixhauser Comorbidity index. The 90-day survival in patients with different delta eGFR was assessed by Kaplan-Meier analysis, univariate and multivariate Cox proportional hazard models. In addition, discrepancy between eGFRcys and eGFRcr was analyzed in 50 ambulatory patients with systemic inflammation but normal kidney function.

Results

Inpatients had higher cysC (median 1.91 mg/L), lower eGFRcys (median 31 mL/min/1.73 m2), and larger delta eGFRcr-cys (median 18 mL/min/1.73 m2) than outpatients (cysC median 1.53 mg/L, p < 0.0001, eGFRcys median 41 mL/min/1.73 m2, p < 0.0001, delta eGFRcr-cys median 4 mL/min/1.73 m2, p < 0.0001). Higher Elixhauser Comorbidity index correlated with lower eGFRcys and larger delta eGFRcr-cys, with median delta eGFRcr-cys 11 and 6 mL/min/1.73 m2 in patients with a Comorbidity index > 15 and ≤ 15, respectively (p < 0.0001). Increased delta eGFRcr-cys was associated with worse 90-day survival. Patients with systemic inflammation but normal kidney function had lower eGFRcys (median 77.5 mL/min/1.73 m2) than eGFRcr (median 97 mL/min/1.73 m2, p < 0.001), with red blood cell abnormalities as associated factors.

Conclusion

Inflammation and comorbidities are associated with decreased eGFRcys and large discrepancies between eGFRcr and eGFRcys independent of kidney function and are most apparent in inpatients. Creatinine-cysC combined eGFR reduces this discrepancy and should be broadly adopted.

目的:通过胱抑素 C(cysC)计算的估计肾小球滤过率(eGFR)已被建议广泛采用。本研究评估了在不同的患者护理环境中用 cysC(eGFRcys)和肌酐(eGFRcr)计算的 eGFR 之间的差异,并探讨了造成这种差异的潜在因素:这项回顾性研究纳入了 2072 名在不同患者护理环境中胱抑素 C 和肌酐结果配对的患者。分析了ΔeGFRcr-cys(eGFRcr - eGFRcys)与患者护理环境和Elixhauser合并症指数的关系。通过 Kaplan-Meier 分析、单变量和多变量 Cox 比例危险模型评估了不同 delta eGFR 患者的 90 天生存率。此外,还分析了 50 名全身炎症但肾功能正常的非住院患者的 eGFRcys 和 eGFRcr 之间的差异:结果:与门诊患者相比,住院患者的 cysC(中位数 1.91 mg/L)较高,eGFRcys(中位数 31 mL/min/1.73 m2)较低,eGFRcr-cys(中位数 18 mL/min/1.73 m2)的 delta 值(cysC 中位数 1.53 mg/L,p 2,p 2,在合并症指数大于 15 和小于 15 的患者中分别为 p 2、p 2、p 2)大于 eGFRcr(中位数 97 mL/min/1.73 m2,p 结论:炎症和合并症是导致慢性肾衰竭的主要原因:炎症和并发症与 eGFRcys 下降以及 eGFRcr 和 eGFRcys 之间的巨大差异有关,与肾功能无关,并且在住院患者中最为明显。肌酐-cysC联合eGFR可减少这种差异,应被广泛采用。
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引用次数: 0
High triglyceride-glucose index and HOMA-IR are associated with different cardiometabolic profile in adults from the ELSA-Brasil study 高甘油三酯-葡萄糖指数和 HOMA-IR 与 ELSA 巴西研究中成年人不同的心脏代谢状况有关。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-10 DOI: 10.1016/j.clinbiochem.2024.110793

Background and aims

Insulin resistance (IR) is a risk factor for several cardiometabolic disorders; however, there is conflicting evidence about the reliability of certain IR markers. In this context, the triglyceride-glucose index (TyG) has been proposed as a surrogate marker for IR. This study aimed to compare the TyG index and homeostasis model assessment of insulin resistance (HOMA-IR).

Methods and results

A cross-sectional analysis was conducted using baseline data from 11,314 adults (aged 35–74 years) from the ELSA-Brasil study. The correlation between TyG and HOMA-IR, their interrater reliability, and their predictive value in identifying metabolic syndrome (MetS) were assessed. The mean TyG and HOMA-IR in our sample were 8.81 ± 0.52 and 2.78 ± 1.58 for men, and 8.53 ± 0.48 and 2.49 ± 1.38 for women, respectively. TyG and HOMA-IR showed a weak to moderate correlation with each other (Pearson’s r for men: 0.395 and 0.409 for women, p-value <0.05) and other markers of glycemic metabolism. Additionally, the area under the curve for the prediction of MetS was greater for TyG than HOMA-IR, regardless of sex (TyG: 0.836 for men and 0.826 for women; HOMA-IR: 0.775 for men and 0.787 for women). The concordance between these markers was low (Coheńs kappa coefficient: 0.307 for men and 0.306 for women). Individuals with increased TyG exhibited mainly anthropometrical and glycemic metabolic alterations, whereas those with elevated HOMA-IR displayed mostly lipid-associated metabolic alterations.

Conclusion

TyG and HOMA-IR might indicate different profiles of cardiometabolic disorders, showing poor agreement in classifying individuals (normal vs. altered) and a weak correlation. Therefore, further studies are needed to investigate the role of TyG as a surrogate marker of IR.

背景和目的:胰岛素抵抗(IR)是多种心脏代谢疾病的风险因素之一;然而,关于某些 IR 标志物的可靠性却存在相互矛盾的证据。在这种情况下,甘油三酯-葡萄糖指数(TyG)被认为是胰岛素抵抗的替代指标。本研究旨在比较TyG指数和胰岛素抵抗稳态模型评估(HOMA-IR):利用 ELSA-Brasil 研究中 11,314 名成人(35-74 岁)的基线数据进行了横断面分析。评估了TyG和HOMA-IR之间的相关性、它们之间的可靠性以及它们在识别代谢综合征(MetS)方面的预测价值。在我们的样本中,男性 TyG 和 HOMA-IR 的平均值分别为 8.81 ± 0.52 和 2.78 ± 1.58,女性分别为 8.53 ± 0.48 和 2.49 ± 1.38。TyG和HOMA-IR之间存在中弱相关性(男性的Pearson's r为0.395,女性为0.409,P值为 结论:TyG和HOMA-IR之间存在中弱相关性(男性的Pearson's r为0.395,女性为0.409,P值为结论):TyG和HOMA-IR可能显示出不同的心脏代谢紊乱情况,在对个体进行分类(正常与改变)时显示出较低的一致性和较弱的相关性。因此,需要进一步研究 TyG 作为红外替代标志物的作用。
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引用次数: 0
Canadian guidance for diagnosis and management of acute hepatic porphyrias 加拿大急性肝卟啉症诊断和管理指南。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-09 DOI: 10.1016/j.clinbiochem.2024.110792

Acute hepatic porphyrias (AHP) comprise four rare monogenic autosomal conditions. Each is linked to a deficiency of heme metabolizing enzymes. Common manifestations include severe abdominal pain, nausea, confusion, hyponatremia, hypertension, tachycardia, and neuropathy. Diagnosis is challenging due to a non-specific, variable presentation with symptoms mimicking other common conditions. Initial diagnosis of AHP can be made with a test for urinary porphobilinogen, δ-aminolevulinic acid and porphyrins using a single random (spot) sample. However, many patients have complications due to delays in diagnosis and management. A novel small interfering RNA-based agent, givosiran, has demonstrated efficacy in reducing acute attacks in a recent Phase III trial, leading to its approval for the management of AHP. Early diagnosis is crucial for the timely introduction of disease-modifying treatments that reduce impairments, enhance quality of life, and extend survival. In this guidance, we aim to improve awareness and outcomes of AHP by making recommendations about diagnosis, monitoring, and treatment in Canada.

急性肝卟啉症(AHP)包括四种罕见的单基因常染色体疾病。每种疾病都与缺乏血红素代谢酶有关。常见表现包括剧烈腹痛、恶心、精神错乱、低钠血症、高血压、心动过速和神经病变。由于该病无特异性,表现多变,症状与其他常见疾病相似,因此诊断具有挑战性。通过使用单个随机(点状)样本检测尿液中的卟啉原、δ-氨基乙酰丙酸和卟啉,可以初步诊断出 AHP。然而,由于诊断和治疗的延误,许多患者出现了并发症。在最近的一项三期试验中,一种基于小核糖核酸的新型药物吉沃西兰(givosiran)被证明在减少急性发作方面具有疗效,因此被批准用于治疗 AHP。早期诊断对于及时采用改变病情的治疗方法至关重要,这些治疗方法可减轻损伤、提高生活质量并延长生存期。在本指南中,我们就加拿大的诊断、监测和治疗提出了建议,旨在提高人们对 AHP 的认识并改善其治疗效果。
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引用次数: 0
Explainable artificial intelligence for LDL cholesterol prediction and classification 用于低密度脂蛋白胆固醇预测和分类的可解释人工智能。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-06 DOI: 10.1016/j.clinbiochem.2024.110791
Sevilay Sezer , Ali Oter , Betul Ersoz , Canan Topcuoglu , Halil İbrahim Bulbul , Seref Sagiroglu , Murat Akin , Gulsen Yilmaz

Introduction

Monitoring LDL-C levels is essential in clinical practice because there is a direct relation between low-density lipoprotein cholesterol (LDL-C) levels and atherosclerotic heart disease risk. Therefore, measurement or estimate of LDL-C is critical. The present study aims to evaluate Artificial Intelligence (AI) and Explainable AI (XAI) methodologies in predicting LDL-C levels while emphasizing the interpretability of these predictions.

Materials and methods

We retrospectively reviewed data from the Laboratory Information System (LIS) of Ankara Etlik City Hospital (AECH). We included 60.217 patients with standard lipid profiles (total cholesterol [TC], high-density lipoprotein cholesterol, and triglycerides) paired with same-day direct LDL-C results. AI methodologies, such as Gradient Boosting (GB), Random Forests (RF), Support Vector Machines (SVM), and Decision Trees (DT), were used to predict LDL-C and compared directly measured and calculated LDL-C with formulas. XAI techniques such as Shapley additive annotation (SHAP) and locally interpretable model-agnostic explanation (LIME) were used to interpret AI models and improve their explainability.

Results

Predicted LDL-C values using AI, especially RF or GB, showed a stronger correlation with direct measurement LDL-C values than calculated LDL-C values with formulas. TC was shown to be the most influential factor in LDL-C prediction using SHAP and LIME. The agreement between the treatment groups based on NCEP ATPIII guidelines according to measured LDL-C and the LDL-C groups obtained with AI was higher than that obtained with formulas.

Conclusions

It can be concluded that AI is not only a reliable method but also an explainable method for LDL-C estimation and classification.

导言:监测低密度脂蛋白胆固醇(LDL-C)水平在临床实践中至关重要,因为低密度脂蛋白胆固醇(LDL-C)水平与动脉粥样硬化性心脏病风险有直接关系。因此,测量或估计低密度脂蛋白胆固醇至关重要。本研究旨在评估人工智能(AI)和可解释人工智能(XAI)预测 LDL-C 水平的方法,同时强调这些预测的可解释性:我们回顾性审查了安卡拉埃特里克市医院(AECH)实验室信息系统(LIS)中的数据。我们纳入了 60.217 名具有标准血脂谱(总胆固醇 [TC]、高密度脂蛋白胆固醇和甘油三酯)和当天直接低密度脂蛋白胆固醇结果配对的患者。梯度提升 (GB)、随机森林 (RF)、支持向量机 (SVM) 和决策树 (DT) 等人工智能方法被用于预测 LDL-C,并将直接测量和计算出的 LDL-C 与公式进行了比较。XAI 技术,如 Shapley 附加注释(SHAP)和局部可解释模型-不可知论解释(LIME),被用来解释人工智能模型并提高其可解释性:结果:使用人工智能(尤其是 RF 或 GB)预测的低密度脂蛋白胆固醇值与直接测量的低密度脂蛋白胆固醇值的相关性强于使用公式计算的低密度脂蛋白胆固醇值。使用 SHAP 和 LIME 预测 LDL-C 时,TC 被证明是影响最大的因素。根据 NCEP ATPIII 指南测量的 LDL-C 治疗组与使用 AI 得出的 LDL-C 组之间的一致性高于使用公式得出的结果:结论:AI 不仅是一种可靠的方法,也是一种可解释的低密度脂蛋白胆固醇估测和分类方法。
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引用次数: 0
The importance of SII and FIB-4 scores in predicting mortality in idiopathic pulmonary fibrosis patients SII 和 FIB-4 评分在预测特发性肺纤维化患者死亡率方面的重要性。
IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2024-07-06 DOI: 10.1016/j.clinbiochem.2024.110789
Gorkem Berna Koyun , Serdar Berk , Omer Tamer Dogan

Introduction

Quick and simple parameters are needed to predict mortality in patients with idiopathic pulmonary fibrosis (IPF). In this way, risky patients will have the opportunity to receive early and effective treatment. In this study, we examined whether the Fibrosis-4 index (FIB-4) and systemic immune inflammation index (SII) are associated with mortality in IPF patients.

Materials and methods

The study was designed retrospectively. 100 patients diagnosed with IPF were included in the study. Variables between living patients and deceased patients were examined.

Results

Out of a total of 100 patients, 67 were divided into the surviving group and 33 into the non-surviving group. In multivariate analysis, high FIB-4 and SII values were significantly associated with an increased risk of death.

Conclusion

FIB-4 and SII are parameters that can predict mortality in IPF patients. In this way, IPF patients with high mortality risk will be identified earlier and more effective methods will be used in follow-up and treatment.

简介:需要快速、简单的参数来预测特发性肺纤维化(IPF)患者的死亡率。这样,高危患者就有机会尽早接受有效治疗。在这项研究中,我们检测了纤维化-4指数(FIB-4)和全身免疫炎症指数(SII)是否与IPF患者的死亡率相关:研究采用回顾性设计。研究纳入了 100 名确诊为 IPF 的患者。结果:在总共 100 例患者中,有 1 例死亡:结果:在总共 100 名患者中,67 人被分为存活组,33 人被分为非存活组。在多变量分析中,FIB-4 和 SII 值越高,死亡风险越大:结论:FIB-4和SII是可以预测IPF患者死亡率的参数。结论:FIB-4 和 SII 是可以预测 IPF 患者死亡率的参数,这样就能更早地发现有高死亡风险的 IPF 患者,并在随访和治疗中采用更有效的方法。
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引用次数: 0
期刊
Clinical biochemistry
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