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1.
Can Serum Nutritional Related Biomarkers Predict Mortality Of Critically Ill Older Patients With Acute Kidney Injury?
Gong, Y, Ding, F, Gu, Y
Clinical interventions in aging. 2019;:1763-1769
Abstract
BACKGROUND Critically ill older patients with acute kidney injury (AKI), also referred to as acute renal failure, are associated with high in-hospital mortalities. Preexisting malnutrition is highly prevalent among AKI patients and increases in-hospital mortality rate. This study is to evaluate the predictive power of some serum nutritional related biomarkers predicting the 90 days in-hospital mortality of critically ill older patients with AKI. METHODS A prospective, observational study was conducted in a university teaching hospital. One hundred and five critically ill older patients with AKI aged 60-95 were enrolled and were divided into survival group (n=44) and non-survival group (n=61) in the light of their final outcomes. Receiver operating characteristic analyses (ROC) were performed to calculate the area under ROC curve (AUC). Sensitivity and specificity of in-hospital mortality prediction were calculated. RESULTS Significant differences were found between the survival group and non-survival group of critically ill older patients with AKI. AUC of low density lipoprotein (LDL) and albumin were 0.686 and 0.595, respectively. The asymptotic 95% confidence intervals of LDL and albumin were 0.524-0.820 and 0.488-0.696, respectively. Sensitivity of the 90 days in-hospital mortality prediction of LDL and albumin were 68.71% and 69.09%, respectively. Specificity of 90 days in-hospital mortality prediction of LDL and albumin were 69.23% and 50.0%, respectively. CONCLUSION LDL and albumin did not have sufficient power to predict the 90 days in-hospital mortality of critically ill older patients with AKI. Further research on the association between malnutrition and poor prognosis of critically ill older patients with AKI is needed in the future.Trial registration: ClinicalTrials.gov identifier: NCT00953992.
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2.
Glycated albumin as a diagnostic tool in diabetes: An alternative or an additional test?
Chume, FC, Kieling, MH, Correa Freitas, PA, Cavagnolli, G, Camargo, JL
PloS one. 2019;(12):e0227065
Abstract
INTRODUCTION Studies have revealed that glycated albumin (GA) is a useful alternative to HbA1c under conditions wherein the latter does not reflect glycaemic status accurately. Until now, there are few studies with non-Asians subjects that report on the validity of GA test in diagnosis of type 2 diabetes mellitus (DM). Thus, the aim of this study was to assess the clinical utility of GA in diagnosis of DM. MATERIALS AND METHODS This diagnostic test accuracy study was performed in 242 Brazilian individuals referred for OGTT in a tertiary university hospital. ROC curves were used to access the performance of GA and HbA1c in the diagnosis of DM by oral glucose tolerance test (OGTT). RESULTS OGTT, HbA1c and GA were performed in all 242 participants (40.5% male, age 54.4 ± 13.0 years [mean ± SD], body mass index 28.9 ± 6.3 kg/m2). DM by OGTT was detected in 31.8% of individuals. The equilibrium threshold value of GA ≥14.8% showed sensitivity of 64.9% and specificity of 65.5% for the diagnosis of DM. The AUC for GA [0.703 (95% CI 0.631-0.775)] was lower than for HbA1c [0.802 (95% CI 0.740-0.864)], p = 0.028. A GA value of 16.8% had similar accuracy for detecting DM as defined by HbA1c ≥6.5% (48 mmol/mol) with sensitivity of 31.2% and specificity of 93.3% for both tests. However, GA detects different subjects from those detected by HbA1c and OGTT. CONCLUSIONS GA detected different individuals with DM from those detected by HbA1c, though it showed overall diagnostic accuracy similar to HbA1c in the diagnosis of DM. Therefore, GA should be used as an additional test rather than an alternative to HbA1c or OGTT and its use as the sole DM diagnostic test should be interpreted with caution.
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3.
Molecular and technical aspects on the interaction of serum albumin with multifunctional food preservatives.
Mohammadzadeh-Aghdash, H, Akbari, N, Esazadeh, K, Ezzati Nazhad Dolatabadi, J
Food chemistry. 2019;:491-498
Abstract
Synthetic food preservatives like sodium acetate (SA), sodium benzoate (SB), potassium sorbate (PS) and Butyl paraben (BP) have been widely used in food and pharmacy industries. One of the toxicological aspects of food additives is evaluation of their interaction with serum proteins such as albumin. These additives interaction with human serum albumin (HSA) can exert considerable effect on the absorption, distribution, metabolism and toxicity of chemical compounds. It should be noticed that the aforementioned food preservatives intake increase mainly in the presence of glucose may lead to complex formation of SA, SB, PS and BP with HSA and accelerate the development of variety disease such as cancer, diabetes, multiple sclerosis, brain damage, nausea and cardiac disease. Therefore, to understand the mechanisms of aforementioned food additives interaction and conformational changes of proteins, we aim to review various studies that investigated albumin interaction with these additives using several procedures.
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4.
Serum Levels of Prealbumin and Albumin for Preoperative Risk Stratification.
Loftus, TJ, Brown, MP, Slish, JH, Rosenthal, MD
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2019;(3):340-348
Abstract
Preoperative risk stratification has long been developed as a strategy to predict postoperative outcomes and potentially alter or optimize comorbidities and modifiable risk. Malnutrition is among the most common potentially modifiable risk factors and the strongest predictor of poor postsurgical outcomes. Historically, malnutrition has been difficult to address for healthcare providers because of the lack of a cohesive definition. Adding to the confusion has been the use of serum levels of albumin and prealbumin as biomarkers for malnutrition; many fail to understand that these visceral proteins are only valid as markers of nutrition status while at homeostasis. Surgical need is often driven by both sterile and non-sterile inflammation, but during this pathologic mechanism, hepatic reprioritization shunts visceral protein synthesis, rendering albumin and prealbumin invalid as biomarkers for malnutrition. Ultimately, understanding these limitations and embracing better indicators of malnutrition will improve preoperative risk stratification.
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5.
Screening for frailty among older patients with cancer using blood biomarkers of inflammation.
Harneshaug, M, Kirkhus, L, Benth, JŠ, Grønberg, BH, Bergh, S, Whist, JE, Rostoft, S, Jordhøy, MS
Journal of geriatric oncology. 2019;(2):272-278
Abstract
INTRODUCTION As frailty is associated with inflammation, biomarkers of inflammation may represent objective measures that could facilitate the identification of frailty. Glasgow prognostic score (GPS), combines C-reactive protein (CRP) and albumin, and is scored from 0 to 2 points. Higher score indicates a higher degree of inflammation. OBJECTIVES To investigate whether (1) GPS is associated with frailty, (2) GPS could be used to screen for frailty, (3) IL-6 and TNF-α add to the accuracy of GPS as a screening tool, and (4) GPS adds prognostic information in frail older patients with cancer. METHODS Prospective, observational study of 255 patients ≥70 years with solid malignant tumours referred for medical cancer treatment. At baseline, frail patients were identified by a modified Geriatric Assessment (mGA), and blood samples were collected. RESULTS Mean age was 76.7 years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPS zero: 43.2%, GPS one: 52.7%, GPS two: 94.7%). GPS two was significantly associated with frailty (OR 18.5), independent of cancer type, stage, BMI and the use of anti-inflammatory drugs. The specificity of GPS was high (99%), but the sensitivity was low (14%). Frail patients with GPS two had poorer survival than patients with GPS zero-one. TNF-α and IL-6 did not improve the accuracy of GPS when screening for frailty. CONCLUSION Frailty and GPS two are strongly associated, and GPS two is a significant prognostic factor in frail, older patients with cancer. The inflammatory biomarkers investigated are not suitable screening tools for frailty.
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The Effect of Continuous Ventilation on Thiol-Disulphide Homeostasis and Albumin-Adjusted Ischemia-Modified Albumin During Cardiopulmonary Bypass.
Ozgunay, SE, Ozsin, KK, Ustundag, Y, Karasu, D, Ozyaprak, B, Balcı, B, Erel, O, Yavuz, S
Brazilian journal of cardiovascular surgery. 2019;(4):436-443
Abstract
OBJECTIVE To investigate the effect of continuous lung ventilation with low tidal volume on oxidation parameters, such as thiol/disulphide homeostasis and albumin-adjusted ischemia-modified albumin (AAIMA), during cardiopulmonary bypass (CBP) in coronary artery bypass grafting (CABG). METHODS Seventy-four patients who underwent elective CABG with CPB were included in the study. Blood samples were taken in the preoperative period, 10 minutes after CPB, and six and 24 hours postoperatively. Patients were assigned to the continuous ventilation group (Group 1, n=37) and the non-ventilated group (Group 2, n=37). The clinical characteristics, thiol/disulphide homeostasis, ischemia-modified albumin (IMA), and AAIMA levels of the patients were compared. RESULTS A significant difference was found between the groups regarding native thiol, total thiol, and IMA levels at the postoperative 24th hour (P=0.030, P=0.031, and P=0.004, respectively). There was no difference between the groups in terms of AAIMA. AAIMA levels returned to preoperative levels in Groups 1 and 2, at the 6th and 24th postoperative hours, respectively. Length of hospital stay was significantly shorter in Group 1 (P<0.001) than in Group 2. CONCLUSION Continuous ventilation during CPB caused an increase in native and total thiol levels, an earlier return of AAIMA levels, and shorter hospital stay. Continuous ventilation may reduce the negative effects of CPB on myocardium (Table 2, Figure 1, and Reference 31).
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7.
Value of Preoperative Modified Body Mass Index in Predicting Postoperative 1-Year Mortality.
Oh, TK, Lee, J, Hwang, JW, Do, SH, Jeon, YT, Kim, JH, Kim, K, Song, IA
Scientific reports. 2018;(1):4614
Abstract
Serum albumin and conventional BMI (cBMI) are commonly used indices of malnutrition status. Because cBMI does not reflect fluid accumulation, modified body mass index (mBMI, serum albumin × cBMI) is a more accurate measure of malnutrition status. This study investigated the association between preoperative mBMI and postoperative 1-year mortality, in comparison with serum albumin and cBMI. Medical records of 80,969 adult patients who underwent surgical procedures in a tertiary care hospital between 1 January, 2011 and 31 December, 2015 were retrospectively reviewed. Postoperative 1-year mortality increased with reduction in cBMI, mBMI, and albumin separately (P < 0.001). When considering interaction between cBMI and albumin, albumin was the only significant factor of postoperative 1-year mortality [odds ratio: 0.377, 95% confidence interval (0.245-0.579), P < 0.001], while cBMI or interaction (cBMI * albumin) was not significant (P > 0.05). Adjusted area under the curve (AUC) was highest (0.885) in the overall model (cBMI + albumin + cBMI * albumin); adjusted AUC between mBMI and albumin did not differ significantly (P = 0.558). Low albumin is the strongest independent predictor of postoperative 1-year mortality among the three variables (albumin, cBMI, mBMI). Adding cBMI to albumin does not increase the validity of the AUC of albumin.
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8.
Nutritional intervention in acute heart failure patients with undernutrition and normalbuminemia: A subgroup analysis of PICNIC study.
Ramiro-Ortega, E, Bonilla-Palomas, JL, Gámez-López, AL, Moreno-Conde, M, López-Ibáñez, MC, Alhambra-Expósito, R, Anguita Sánchez, M
Clinical nutrition (Edinburgh, Scotland). 2018;(5):1762-1764
Abstract
BACKGROUND & AIMS Hypoalbuminemia is common in acute heart failure (HF) patients and has been associated with increased hospital mortality and long-term mortality. Undernutrition is a factor causing hypoalbuminemia. The PICNIC study results show that a nutritional intervention in undernourished acute HF patients reduces the risks of all-cause death and of readmission for HF. We aimed to investigate whether the efficacy of a nutritional intervention is consistent among the subgroups of patients with and without hypoalbuminemia. METHODS In PICNIC study, a total of 120 malnourished hospitalized patients due to acute HF were randomized to conventional HF treatment or conventional HF treatment combined with an individualized nutritional intervention. The primary endpoint was a composite of all-cause death or readmission for worsening of HF, with a maximum follow-up of 12 months. In this post-hoc sub-analysis we assessed the interaction of the effects of a nutritional intervention among patients with and without hypoalbuminemia. Analysis was by intention to treat. RESULTS 59 (49,2%) patients demonstrated hypoalbuminemia and 61 (50,8%) had normalbuminemia. At 12 months, the number of events for the primary endpoint in the intervention group compared with the control group was consistent among patients with hypoalbuminemia (28.6% intervention vs 61.3% control, HR 0,35, 95% CI 0,15-0,81) and those without (25.8% intervention vs 60% control, HR 0,35, 95% CI 0,15-0,79; interaction p = 0,86). CONCLUSION There was no evidence that the relative efficacy of a nutritional intervention in undernourished acute HF patients was different between patients with normalbuminemia and those with hypoalbuminemia.
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Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus.
Mendes, N, Tavares Ribeiro, R, Serrano, F
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2018;(6):762-769
Abstract
Strict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2-3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.
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10.
Effect of Oral Branched-Chain Amino Acids on Serum Albumin Concentration in Heart Failure Patients with Hypoalbuminemia: Results of a Preliminary Study.
Uchino, Y, Watanabe, M, Takata, M, Amiya, E, Tsushima, K, Adachi, T, Hiroi, Y, Funazaki, T, Komuro, I
American journal of cardiovascular drugs : drugs, devices, and other interventions. 2018;(4):327-332
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Abstract
BACKGROUND We conducted a randomized, controlled trial to determine whether supplementation with oral branched-chain amino acids (BCAAs) improves serum albumin and clinical outcomes in heart failure (HF) patients with hypoalbuminemia. METHODS AND RESULTS We randomly assigned 18 in-hospital HF patients with serum albumin < 3.5 g/dL to receive oral BCAA granules (LIVACT®) for 28 days during their hospital stay or until discharge (BCAA group; N = 9) or to receive no supplementation (controls; N = 9), in addition to recommended HF therapy. The primary endpoints were changes from baseline in serum albumin and cardiothoracic ratio (CTR). Sixteen patients completed the study. The mean (± standard deviation) period of BCAA supplementation was 18.4 ± 8.4 days. Serum albumin significantly increased in the BCAA group [mean difference vs baseline, 0.44 g/dL; 95% confidence interval (CI) 0.13-0.76; P = 0.014] and did not change in controls (0.18 g/dL; 95% CI - 0.05 to 0.40; P = 0.108). CTR significantly decreased in the BCAA group (- 2.3%; 95% CI - 3.8 to - 0.8; P = 0.014) and did not change in controls (- 1.0%; 95% CI - 2.3 to 0.3; P = 0.111). CONCLUSION In-hospital HF patients with hypoalbuminemia supplemented with BCAAs showed increased serum albumin and decreased CTR. Clinical trial registration number UMIN000004488 [ http://www.umin.ac.jp/ctr/index.htm ].