Clinical chemistry最新文献

Background: Promoting self-empowerment of patients and of healthy persons in contemporary health cultures shifts the imperative for initiating laboratory tests from the healthcare professionals (HCP) to the patients themselves.

Content: Laboratory testing requested directly by patients without interaction by HCP is called DTCT (direct-to-consumer testing). DTCT is not conducted within traditional healthcare systems, and the regulations that protect the patients in healthcare are not necessarily present in DTCT. Aggressive marketing of DTCT may mislead the consumer, resulting in psychological, physical, and financial harm. The benefit of laboratory testing is dependent on being used on selected persons, with samples collected and stored appropriately, measured with an adequate technique and the test results interpreted properly. DTCT can empower patients, but consumer knowledge varies and currently, there is a lack of reliable resources for consumers to consult. In the absence of healthcare protection rules for DTCT, the concept of informing consumers concurrently with marketing DTCT by the vendors is not in place.

Summary: DTCT might be advantageous over traditional testing settings in a few selected situations but has a substantial risk of medicalization of healthy persons and damaging the trust in the reliability of healthcare laboratory testing.

Background: Increasing numbers of transgender and gender-diverse individuals are seeking initiation of gender-affirming hormone therapy. This aligns an individual's physical characteristics with their gender identity and improves psychological outcomes. Physical changes, including changes to muscle mass and body fat redistribution, can alter sex-specific laboratory reference ranges.

Content: We review the impact of gender-affirming hormone therapy on laboratory parameters with sex-specific reference ranges, with a focus on hemoglobin/hematocrit, renal function, cardiac biomarkers, and prostate-specific antigen.

Summary: Gender-affirming hormone therapy results in changes in laboratory parameters with sex-specific reference ranges. For individuals established on gender-affirming hormone therapy, reference ranges that align with an individual's gender identity should be used for hemoglobin/hematocrit, serum creatinine, and high-sensitivity cardiac troponin and N-terminal brain natriuretic peptide. Clinicians should interpret these biomarkers according to the reference range that aligns with one's affirmed gender.

Background: Given the close relationship between cardiovascular disease (CVD) and malnutrition, we examined whether higher concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP), which indicate CVD risk in the general population, were prospectively associated with malnutrition incidence in community-dwelling older adults without CVD.

Methods: We used data from 1490 individuals ≥65 years from the Seniors-ENRICA-2 cohort followed up for 2.2 years. Malnutrition was evaluated by the screening Mini Nutritional Assessment-Short Form (MNA-SF) score, which consists of a short questionnaire, and a complete nutritional assessment according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Associations were summarized with odds ratios (OR) and their 95% confidence interval (CI), obtained from logistic regression and adjusted for the main confounders.

Results: NT-proBNP was associated with higher malnutrition incidence assessed by the MNA-SF score and the GLIM criteria, with OR (95% CI) of 1.51 (1.09-2.09) and 1.43 (1.04-1.96) per one logarithmic-unit increment, respectively. Malnutrition incidence according to the GLIM criteria was also higher in participants who had elevated NT-proBNP (heart stress age-specific rule-in cutoffs) vs those who did not, with OR (95% CI) of 1.84 (1.05-3.22). hs-cTnT was not associated with higher malnutrition incidence.

Conclusions: In this cohort of older adults without CVD, NT-proBNP was associated with higher malnutrition incidence. Further research is needed to validate our findings, uncover the underlying biological mechanisms, and assess whether preventive interventions can reduce NT-proBNP concentrations and, consequently, reduce the risk of malnutrition.