Prognostic value of serum albumin and C-reactive protein levels in the elderly for assessing morbidity and mortality in a tertiary care center

Introduction: There is an increased population of elderly globally due to advancement of technology in health care. Elderly individuals are susceptible to various diseases, owing to deficits in nutrition or healthy lifestyle. Serum albumin and C‑reactive protein (CRP) are found to be sensitive to nutritional status as well as inflammation. This study is an attempt to analyze the prognostic value of CRP and serum albumin and analyze its usefulness as a prognostic marker in assessing morbidity and mortality in elderly patients. Methodology: One hundred patients above the age of 65 years and were admitted to the emergency care facilities of our tertiary care center were recruited for the study. Serum albumin and CRP estimation was done on the day of admission along with Charlson Comorbidity Index (CCI), and was follow-up till discharge. Statistical analysis was performed to evaluate relationship between the serum values and CCI scores. Results: It was observed that 83.3% (10/12) of deaths occurred in those with low serum albumin levels, and 91.6% (11/12) with high CRP levels. The hazard ratio shows a 6% increased probability of death with one unit increase in CRP, whereas a one unit increase in serum albumin value decrease the probability of death. Conclusion: The present study concludes that low serum albumin and high CRP levels at the time of admission in the elderly population are associated with high CCI scores, longer hospital stay, and increased risk of mortality, demanding their estimation in the elderly in emergency and acute care facilities.

Reno-protective effect of N-acetyl cysteine in patients with impaired renal function undergoing coronary angiography and interventions.

BACKGROUND: The increasingly frequent use of contrast enhanced imaging for diagnosis or interventions in patients with CAD has generated concern about avoidance of contrast induced nephropathy (CIN). Reactive oxygen species have been shown to cause CIN. OBJECTIVES: Angiographic contrasts worsen the renal function in patients with renal failure. We studied the reno-protective action of the antioxidant N-Acetyl cysteine (NAC) in patients undergoing coronary procedures. METHODS: Retrospective analysis of 51 patients with elevated serum creatinine levels (> or = 15mg%) was done, 24 of whom received NAC prior to the procedure(NAC group) and 27 who did not (Non NAC group). NAC was administered in a dose of 400 mg twice daily for four doses starting on the day prior to the procedure. Both groups of patients were hydrated with 0.45% saline at 1 ml/kg/hr for 12 hours prior to and 12 hours following the procedure. Both groups were comparable with regard to age, sex, coronary risk profile, myocardial infarction history, left ventricular function and the drugs received. Serum urea and creatinine were measured on the day prior to and the day following the angiographic procedure. RESULTS: Nine out of 51 patients developed more than 0.5mg% rise in serum creatinine level; 1 in the NAC group and 8 in the non NAC group (p<0.05), 24 hours after injection of the contrast medium. In the NAC group mean serum creatinine level decreased from 1.94 +/- 0.56 to 1.67 +/- 0.56 and blood urea from 47.58 +/- 20 to 41.58 +/- 15.1. In the non NAC group serum creatinine increased from 1.75 +/- 0.31 to 1.98 +/- 0.56 and blood urea from 44.96 +/- 15.5 to 52.85 +/- 20.1 (p<0.05). This corresponds to an increase in creatinine clearance from 30ml/min to 35.92ml/min in the NAC group and a decrease from 34.42ml/min to 29.87ml/min in the non NAC group. There was no significant difference in the levels of sodium and potassium before and after the procedure in both the groups. CONCLUSION: We conclude that prophylactit administration of N-Acetyl Cysteine along with hydration diminishes the incidence of deterioration of renal function induced by contrast agents in patients with renal insufficiency during coronary angiographic procedures.

Genetic polymorphisms of CYP2E1 and GSTP1 in a South Indian population--comparison with North Indians, Caucasians and Chinese.

CYP2E1 and GSTP1 enzymes belong to phase I and phase II group of drug metabolizing enzymes respectively which are involved in the metabolic activation and detoxification of various potential genotoxic compounds. The functional polymorphism in these genes exhibit inter-individual variations in susceptibility towards various diseases and difference in therapeutic response. The variant sequences of these genes differ considerably between ethnic groups. Therefore, the objective of the study was to assess the prevalence of CYP2E1 & GSTP1 gene variants in healthy volunteers of Tamilnadu, a population of South India. The genotype distribution of CYP2E1*1B A2A2, A2A1 and A1A1 were 61%, 36% and 3% respectively. The distribution of CYP2E1*5B c1c1, c1c2 genotypes were 99.2%and 0.8%. CYP2E1*6 DD, DC and CC genotype frequencies were 72%, 25% and 3% respectively. The allele frequencies of CYP2E1*1B, CYP2E1*5B and CYP2E1*6 were A2- 0.79 A1- 0.21, c1-0.996 c2 - 0.004 and D- 0.84 C- 0.16 respectively. The genotypic distribution of GSTP1 (Ile/Val) were Ile/Ile - 44%, Ile/Val -47% and Val/Val- 9 % whereas, the allelic frequencies were 0.67 for Ile and 0.33 for Val allele. The molecular studies in these enzymes provide basis for further epidemiological investigations in the population where the functional mutations in the genes alter therapeutic response and acts as susceptibility markers for various clinical conditions.