ABSTRACT
Microalbuminuria is an early biomarker of general vascular dysfunction and a predictor of risk for cardiovascular and renal diseases. It is also considered as a marker of insulin resistance in both diabetic and non-diabetic patients. The rationale of this study was to elucidate threshold values of fasting blood glucose (FBS) and glycosylated hemoglobin (HbA1c) that are associated with microalbuminuria. In the parallel association of microalbuminuria with hyperhomocysteinemia was investigated. Machine learning algorithm and multiple linear regression were applied to study the association of poor glycemic control on microalbuminuria and hyperhomocysteinemia. In non-diabetic subjects with FBS <102 mg/dL and HbA1c <6.3%; and in diabetic subjects with good glycemic control (FBS: 102-118 mg/dL; HbA1c: 6.3-7.0%), urinary microalbumin levels were <40µg/mg creatinine. Poor glycemic control (FBS >172 mg/dL and HbA1c >9.0%) was associated with microalbumin >40µg/mg creatinine. Age, gender, HbA1c and FBS were shown to explain variability in urinary microalbumin to the extent of 54.4% as shown by multiple linear regression model. Analysis of variance (ANOVA) revealed higher levels of FBS (F: 39.77, P <0.0001), HbA1c (F: 64.31, P <0.0001) and total plasma homocysteine (F: 3.69, P =0.04) in microalbuminuria and clinical microalbuminuria groups when compared to subjects with normal microalbumin levels. Diabetic patients with poor glycemic index had a more B12 deficiency. Poor glycemic index and hyperhomocysteinemia were associated with clinical microalbuminuria.
ABSTRACT
Background: It is very important to distinguish between non-infectious systemic inflammatory response (SIRS) and culture negative sepsis as the management of the two conditions is different this often creates diagnostic challenge in day to day practice. The aim of present study is to investigate the diagnostic accuracy of serum PCT and CRP to differentiate between culture negative bacterial sepsis and non-infective SIRS. We have also studied their diagnostic efficacy in culture-positive sepsis. Materials and methods: 178 cases who were admitted in acute medical care unit in tertiary care centre, were included in the study. The cases were divided into three groups. Group I (culture positive sepsis) patients with positive microbial culture and 2 or more signs of sepsis. Group II (culture negative sepsis) includes patients with 2 or more sign of SIRs and clinical suspicion of infection with negative culture result. Group III (non-infective SIRs) includes patient with 2 or more sign of SIRS without evidence of any infection. Samples were collected for blood culture, differential count, PCT and CRP along with other routine investigation. The diagnostic performance of PCT and CRP was demonstrated with ROC curve analysis. Results: The median Procalcitonin was approximately 9 fold higher in culture negative group compared to non-infective SIRS and it was statistically significant (P<0.01) whereas CRP showed Siraj Ahmed Khan, Iyyapu Krishna Mohan, Bhavya Sirivelu, Rachel Jacob. Role of Procalcitonin and C-reactive protein in differentiating culture negative bacterial sepsis and systemic inflammatory response. IAIM, 2017; 4(3): 24-29. Page 25 only 2-3 fold increase between these groups. ROC curve analysis for PCT and CRP between culture negative and SIRS groups for prediction of systemic infection were performed. The area under the curve for PCT and CRP were 0.986 and 0.785 respectively. Conclusion: Biomarkers such as PCT and CRP are strongly associated with infection likelihood and sepsis and they can serve as useful adjuncts to routine clinical information. These markers were also able to distinguish between patients with non-infective SIRS and sepsis.