Predictors of asymptomatic cardiac events and prognostic value of cardiac biomarkers in chronic kidney disease patients

Patients with chronic kidney disease [CKD] are at increased risk of cardiovascular events; cardiovascular disease is a leading cause of death in patients with chronic kidney disease; Circulating biomarkers play a major role in the early detection of cardiovascular disease in those patients. To clarify the prevalence of asymptomatic different cardiac events in CKD and to explore the degree of elevation of N- terminal-pro-B-type Natriuretic Peptide [NT-pro-BNP] in asymptomatic cardiac patients with varying degree of CKD and the relationship between the elevation of this biomarker and the occurrence of these cardiac complications. This case-control study included 40 CKD patients and 40 controls; patients were recruited from nephrology unit of internal medicine department; Assiut university hospital; known to have chronic kidney disease in different grades [grade I- grade V]. Resting transthoracic echocardiography [TTE] and plasma NT-pro-BNP concentrations were measured in patients who were asymptomatic for clinical evidence of any cardiac events, [n=40; mean age 47.63 +/- 17.93 years; 52.5%were males] as well as healthy volunteers n=40; mean age 42.00 +/- 13.25; 62% were males]. In addition, the correlation between plasma NT-pro-BNP concentration and parameters of echocardiography was examined. Increased prevalence of left ventricular hypertrophy [LVH] [70%]; left ventricular diastolic dysfunction [77.5%], left ventricular systolic dysfunction [17.5%] and coronary artery disease [27.5%] in CKD patients as well as serum NT-pro-BNP levels in the patients were significantly higher [6703.75 +/- 2947.68 pg/ml] than those in healthy volunteers [124.83 +/- 140.40 pg/ml] [p=0.000]. NT-pro-BNP level was higher also in patients who had hypertension [p=0.002]; anemia [p-0.004]; hypoalbuminamia [p=0.000];left ventricular hypertrophy [LVH] [7873. 57 +/- 2719. 31 pg/ml] [p = 0.000], diastolic dysfunction [7524. 52 +/- 2824.74 pg/ml] [p= 0.000]; systolic dysfunction [10371.43 +/- 2771.71] [p=0.000] and patients who had segmental wall motion abnormality [SWMA] [8709.0.9 +/- 3512.3.9] [p=0.000] and correlate Positively with C reactive protein [CRP] level [r-0.751 p=0.000]; left ventricular mass [LVM] [r=0.772 p=0.000] and left ventricular mass index [LVMI] [r=0.715 p=0.000] and negatively with ejection fraction [EF] by echocardiography [r=-0.483 p=0.000]. NT-pro-BNP level elevation in asymptomatic patients with CKD reflects underlying cardiac dysfunction, ischemic heart disease and hypertrophy independent of renal function

Inflammatory mediators in plasma and peritoneal fluid in cirrhotic patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] in cirrhotic patients is associated with an increased production and decreased metabolism of inflammatory mediators [cytokines] such as tumour necrosis factor a [TNF-alpha], interleukin 6 [IL-6] and interleukin 1-beta [IL-l beta]. The present study was designed to investigate the relationship between the development of SBP and the degree of inflammatory response in patients with liver cirrhosis and to assess the diagnostic value of the inflammatory mediators in cirrhotic patients with SBP. This study was carried out on 46 cirrhotic patients with SBP, 22 cirrhotic patients with ascites but without evidence of SBP, and 12 healthy subjects as a control group. All patients were subjected for history taking, clinical examination and abdominal ultrasound. Blood samples were collected for complete blood count [CBC], liver function tests and measurement of TNF-alpha, IL- l beta, and IL-6 levels [in patients and control]. Ascitic fluid samples were collected for measurement of TNF-alpha, IL- l beta, and IL-6 and for aerobic and anaerobic cultures [only in patients with SBP]. Cirrhotic patients with SBP showed significantly higher plasma and ascitic fluid levels of TNF-alpha, IL- l beta and IL-6 than cirrhotic patients without SBP [despite that severity of liver disease was similar in the two groups] and normal control subjects [p<0.001]. Ascitic fluid TNF-alpha, IL- l beta and IL-6 were also higher in the cirrhotic patients with SBP than in plasma, [p<0.001 for each]. Also the plasma levels of TNF-alpha, IL- l beta and IL-6 in cirrhotic patients with SBP were significantly higher than in healthy control subjects [p<0.001]. There was a strong direct correlation between plasma and ascitic fluid levels of TNF-alpha, [r=0.9624, p<0.001] IL-l beta [r=0.4024, p<0.01], and IL-6 [r=0.2890, p<0.05] at the time of diagnosis of SBP. A significant correlation was also observed between TNF-alpha, IL- l beta, and IL-6 in ascitic fluid [r=1.0000, p<0.001] and in plasma [r=0.8500, p<0.001]. PMN cell count in ascites correlated significantly with the ascitic fluid level of IL- l beta [r=0.3156, p<0.05], but did not correlate with both TNF-alpha [r-0.0953, p>0.05] and IL-6 [r=0.0702, p>0.05]. Patients with culture-positive SBP showed significantly higher plasma and ascitic fluid levels of TNF-alpha, IL- l beta, and IL-6 than patients with culture-negative SBP. The PMN cell count in the ascitic fluid was also significantly higher in the culture-positive vs culture-negative SBP patients [6.813 +/- 0.24 vs 1.36110.07, p<0.001]. Cirrhotic patients with SBP display a marked increase of TNF-alpha, IL- l beta, and IL-6 levels in ascitic fluid and plasma. Specificity and sensitivity of these cytokines detection of SBP in cirrhotic patients strongly favor its measurement during acute phase of the disease