Valor pronóstico de la proteína fijadora de lipopolisácaridos y la procalcitonina en pacientes consepsis grave y shock séptico ingresados en una unidad de cuidados intensivos / Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to intensive care

OBJETIVOS: 1) Valorar la utilidad pronóstica de la determinación inicial y seriada de la proteína fijadora de lipopolisacáridos (LBP) y de la procalcitonina (PCT) y 2) evaluar si su adicción a los scores de gravedad mejoraría su valor pronóstico. DISEÑO: Estudio prospectivo observacional. ÁMBITO: Unidad de Cuidados Intensivos de un hospital general universitario. PACIENTES: Se incluyó a 100 pacientes ingresados por sepsis grave/shock séptico. Variables de interés Datos demográficos, APACHE II y SOFA, concentración de PCT y LBP inicial y a las 48 h y mortalidad hospitalaria. RESULTADOS: Los scores APACHE II al ingreso y SOFA a las 48 h presentaron el mayor rendimiento como predictores de mortalidad hospitalaria (AUC ROC: 0,75 para ambos). La concentración inicial de PCT y LBP y el aclaramiento de LBP fueron similares en pacientes supervivientes y fallecidos. Solo el aclaramiento de PCT fue superior en supervivientes respecto a los fallecidos (AUC ROC: 0,66). La combinación de los scores de gravedad con el aclaramiento de PCT no mejoró su valor pronóstico. CONCLUSIONES: La concentración inicial de LBP y de PCT y el aclaramiento de LBP no presentaron valor pronóstico en pacientes con sepsis grave/shock séptico. Solo el aclaramiento de PCT se comportó como predictor de mortalidad hospitalaria. El rendimiento de los scores APACHE II al ingreso y SOFA a las 48 h fue superior al de los biomarcadores analizados y la adición del aclaramiento de PCT no aumentó su valor pronóstico

AIMS: 1) To assess the prognostic value of levels on admission and serial measurements of lipopolysaccharide binding protein (LBP) and procalcitonin (PCT) in relation to in-hospital mortality; and 2) to determine whether the addition of these parameters to severity scores (APACHE II and SOFA) is able to improve prognostic accuracy. DESIGN: A single-center, prospective observational study was carried out. Setting Intensive Care unit of a university hospital. PATIENTS: One hundred severe sepsis and septic shock patients were included. Data collected Demographic data, APACHE II and SOFA scores, PCT and LBP levels on admission and after 48hours, and in-hospital mortality. RESULTS: The best area under the curve for predicting in-hospital mortality corresponded to APACHE II on admission and SOFA after 48h (AUC ROC: 0.75 for both). PCT and LBP levels on admission and LBP clearance were not statistically different between in-hospital survivors and non-survivors. Only PCT clearance was higher among in-hospital survivors than in non-survivors (AUC ROC: 0.66). The combination of severity scores and PCT clearance did not result in superior areas under the curve. CONCLUSIONS: LBP and PCT levels on admission and LBP clearance showed no prognostic value in severe sepsis and septic shock patients. Only PCT clearance was predictive of in-hospital mortality. The prognostic accuracy was significantly better for APACHE on admission and SOFA after 48h than for any of the analyzed biomarkers, and the addition of PCT clearance did not improve their prognostic value

[Usefulness of copeptin in discarding non-ST elevation acute myocardial infarction in patients with acute chest pain and negative first troponin I]. / Valor de la copeptina para la exclusión del infarto agudo de miocardio sin elevación del segmento ST en pacientes con dolor torácico y primera troponina negativa.

AIM: To evaluate the usefulness of copeptin as a rapid and reliable marker for discarding non-ST elevation acute myocardial infarction (NSTEMI) in patients attended in an Emergency Care Department due to acute chest pain with a normal or non-diagnostic electrocardiogram and a negative first troponin I result. DESIGN: A prospective observational study was carried out. SETTING: The Emergency Care Department of a university hospital. PATIENTS: The study comprised a total of 97 patients attended in the Emergency Care Department due to chest pain suggestive of acute coronary syndrome with an evolution of under 12h, a non-diagnostic electrocardiogram and a negative first troponin I result. INTERVENTIONS: None. VARIABLES OF INTEREST: Patient demographic data and baseline characteristics, copeptin upon admission, troponin I upon admission and after 6h, and final diagnosis. RESULTS: The final diagnosis was NSTEMI in 14 patients (14.4%) -no significant differences in copeptin concentration being observed between the 2 groups, though a tendency towards higher values was recorded in the NSTEMI group (median: 24.6pmol/l [interquartile range: 42.0] vs. 12.0pmol/l [16.1]; P=.06). The AUC ROC for copeptin upon admission was 0.657 (95%CI: 0.504-0.810), with a negative predictive value of 92% for a cutoff point of 14pmol/l. CONCLUSIONS: Copeptin determination upon admission to the Emergency Care Department in patients with chest pain for ≤12h, suggestive of acute coronary syndrome, with a non-diagnostic electrocardiogram and a negative first troponin I determination does not allow rapid and reliable exclusion of the presence of NSTEMI. Serial troponin I measurements are needed in this respect.

[Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to intensive care]. / Valor pronóstico de la proteína fijadora de lipopolisácaridos y la procalcitonina en pacientes con sepsis grave y shock séptico ingresados en una unidad de cuidados intensivos.

AIMS: 1) To assess the prognostic value of levels on admission and serial measurements of lipopolysaccharide binding protein (LBP) and procalcitonin (PCT) in relation to in-hospital mortality; and 2) to determine whether the addition of these parameters to severity scores (APACHE II and SOFA) is able to improve prognostic accuracy. DESIGN: A single-center, prospective observational study was carried out. SETTING: Intensive Care unit of a university hospital. PATIENTS: One hundred severe sepsis and septic shock patients were included. DATA COLLECTED: Demographic data, APACHE II and SOFA scores, PCT and LBP levels on admission and after 48 hours, and in-hospital mortality. RESULTS: The best area under the curve for predicting in-hospital mortality corresponded to APACHE II on admission and SOFA after 48 h (AUC ROC: 0.75 for both). PCT and LBP levels on admission and LBP clearance were not statistically different between in-hospital survivors and non-survivors. Only PCT clearance was higher among in-hospital survivors than in non-survivors (AUC ROC: 0.66). The combination of severity scores and PCT clearance did not result in superior areas under the curve. CONCLUSIONS: LBP and PCT levels on admission and LBP clearance showed no prognostic value in severe sepsis and septic shock patients. Only PCT clearance was predictive of in-hospital mortality. The prognostic accuracy was significantly better for APACHE on admission and SOFA after 48 h than for any of the analyzed biomarkers, and the addition of PCT clearance did not improve their prognostic value.

The type of fat ingested at breakfast influences the plasma lipid profile of postmenopausal women.

To assess whether the type of fat ingested at breakfast can modify the plasma lipid profile and other cardiovascular risk variables in postmenopausal women at risk of cardiovascular disease, a longitudinal, randomized, and crossover study was carried out with postmenopausal women at risk of CVD. They were randomly assigned to eat each type of breakfast during one month: 6 study periods (breakfast with the same composition plus butter/margarine/virgin olive oil) separated by two washout periods. On the first and last days of each study period, weight, arterial blood pressure, heart rate, and body mass index were recorded in fasting conditions and a blood sample was collected to measure plasma lipid profile. When comparing final values to baseline values, we only found out statistically significant differences on plasma lipid profiles. Butter-based breakfast increased total cholesterol and HDL, while margarine-based breakfast decreased total cholesterol and LDL and increased HDL. After the olive oil-based breakfast intake, a tendency towards a decrease of total cholesterol and LDL levels and an increase of HDL levels was observed. No statistically significant differences were observed in triglycerides levels, BMI, and arterial pressure in any breakfast type. The margarine-based breakfast was the only one which significantly increased the percentage of volunteers with optimal lipid profiles. The polyunsaturated fat at breakfast has improved the plasma lipid profile in the analyzed sample population, suggesting that PUFA-based breakfast can be advisable in women at risk of CVD.

[The use of a simple algorithm to improve proteinuria diagnosis in clinical laboratories]. / Implantación en el laboratorio de un algoritmo para el diagnóstico diferencial de la proteinuria.

BACKGROUND AND OBJECTIVE: When proteinuria appears, a differential diagnosis must determine its origin. The object of this work has been to evaluate the results after the laboratory implantation of an algorithm for the screening and diagnosis of proteinuria. MATERIAL AND METHODS: From a total of 30,718 processed urines, a 30 mg/dl or higher protein concentration was obtained in 639, recommending a new sample to confirm and differentiate proteinuria. We received 207, to which total protein, creatinine, albumin and alpha-1-microglobulin were quantified, together with pseudoperoxidase and leukocyte esterase from dipstick. The results were introduced in an expert system (UPES and its application Protis), allowing differentiate hematuria, leukocyturia and proteinuria and suggesting the assessment of other parameters, like IgG, alpha-2-macroglobulin, light chain kappa/lambda, when necessary. RESULTS: From 207 urinalysis assayed for selective proteinuria, 39 were normal, 96 were classified as primary glomerulopathy, 26 as secondary glomerulopathy and 5 as tubulo-interstitial nephropathy. A differential diagnosis of hematuria was made in 58 of these urines. Besides, kappa light chains were detected in a sample from a patient with a normal serum protein graph, which were confirmed by immune fixation. CONCLUSION: With the proposed algorithm, the information obtained from a urine sample increases substantially, allowing detection and differentiation of proteinuria and providing suggestions for the clinical evaluation of the patient.

Evaluación de un método de ultracentrifugación en gradiente de densidad para la cuantificación de colesterol y triglicéridos en las lipoproteínas HDL, LDL y VLDL / Quantification of cholesterol and triglycerides in HDL, LDL and VLDL lipoproteins using a density gradient ultracentrifugation method

OBJETIVO: Adaptación de un método de ultracentrifugaciónen gradiente de densidad isopícnico para la separación analíticade de las tres principales lipoproteínas de interés clínico.MATERIAL Y MÉTODOS: Se procesaron 337 muestras, enuna ultracentrífuga Beckman L-80 con un rotor Vti 65.2, a416.000g durante 55 minutos a 10ºC. Los tubos de ultracentrifugación(5.1ml), se prepararon introduciendo 1ml de suero,previamente ajustado a una densidad de 1.210 Kg/l con BrK, yse rellenaron con una solución de BrK de densidad 1.006Kg/l.RESULTADOS: La fracción de HDL se recogió en los primeros1.7 ml, la de LDL en los siguientes 2.5 ml y la de VLDL enlos últimos 0.9 ml del volumen total. Los CV intraensayo oscilaronentre 0.71 y 11.41% y los CV interensayo entre 1.53 y11.11%. Los coeficientes de correlación fluctuaron entre0.707 y 0.982.CONCLUSIONES: El método de ultracentrifugación en gradientede densidad isopícnico propuesto es sencillo y fiable,permite separar las tres principales lipoproteínas (HDL, LDL yVLDL) y cuantificar independientemente en cada una de ellascolesterol y triglicéridos, en un único paso, en sólo 55 minutosy con un volumen de muestra mínimo (1ml). Lo consideramosun método útil cuando los métodos directos no son suficientementeexactos y cuando se necesita cuantificar los triglicéridos

OBJECTIVE, Adaptation of the ultracentrifugation metodologyin isopicnic density gradient with a vertical rotor to get theanalytical isolation of the three main lipoproteins for clinicaluse.DESIGN AND METHOD, Blood samples were obtained from337 subjects admitted at our Hospital. Sera were adjusted to1.210 kg/L density with KBr and filled with a 1.006 kg/L densityKBr solution. Tubes were processed in L-80 Beckman ultracentrifugeusing a VTi 65.2 rotor at 416 000g for 55 min at10ºC. RESULTS, HDL fraction was collected from initial until upto 1.7 mL, LDL fraction in the following 2.5 mL and VLDL fractionin the last 0.9 mL.The intraassay CVw were 0.71-11.41% and the interassayCVb, 1.53-11.11%. The correlation coefficients fluctuatedbetween 0.707-0.982.CONCLUSIONS, We propose a modified isopicnic densitygradient ultracentrifugation method that is both an easy and reliable technique, which separates and quantifies cholesteroland triglycerides in the three main lipoproteins (HDL, LDL andVLDL) independently, in one step, in a short time (55 min) andwith a minimal sample volume (1 mL).Therefore it is an useful method when direct methods are notaccurate enough and when quantification of triglycerides is needed

Modificaciones cualitativas de las lipoproteínas. Implicaciones fisiopatológicas / Qualitative modifications of lipoproteins: physiopathologic implications

Las enfermedades cardiovasculares siguen siendo en la mayoría de los países la causa principal de mortalidad. El proceso arteriosclerótico es producto de las diversas interacciones entre elementos de la sangre (proteinas, lípidos y células) y la pared arterial. La lesión ateromatosa es morfológicamente distinta según la progresión de la enfermedad coronaria. Las lipoproteínas de baja densidad (LDL) son reconocidas como lipoproteínas aterogénicas, especialmente las "LDL modificadas". Estas modificaciones cualitativas (oxidación, glicación, reducción de tamaño, aumento de densidad) están directamente implicadas en el inicio y aceleración del proceso arteriosclerótico y son asimismo responsables de los mecanismos inmunológicos implicados en la patogénesis de la aterosclerosis. En el suero de pacientes diabéticos se han detectado diversos tipos de lipoproteínas modificadas, incluyendo LDL glicadas, oxidadas y glicoxidadas, así como autoanticuerpos e inmunocomplejos que potencian y contribuyen a la aceleración de la aterosclerosis y al consiguiente riesgo incrementado de padecer enfermedades cardiovasculares (AU)