Procalcitonin levels predict acute kidney injury and prognosis in acute pancreatitis: a prospective study.

BACKGROUND: Acute kidney injury (AKI) has been proposed as a leading cause of mortality for acute pancreatitis (AP) patients admitted to the intensive care unit (ICU). This study investigated the predictive value of procalcitonin (PCT) for AKI development and relevant prognosis in patients with AP, and compared PCT's predictive power with that of other inflammation-related variables. METHODS: Between January 2011 and March 2013, we enrolled 305 cases with acute pancreatitis admitted to ICU. Serum levels of PCT, serum amyloid A (SAA), interleukin-6 (IL-6), and C reactive protein (CRP) were determined on admission. Serum PCT was tested in patients who developed AKI on the day of AKI occurrence and on either day 28 after occurrence (for survivors) or on the day of death (for those who died within 28 days). RESULTS: Serum PCT levels were 100-fold higher in the AKI group than in the non-AKI group on the day of ICU admission (p<0.05). The area under the receiver-operating characteristic (ROC) curve of PCT for predicting AKI was 0.986, which was superior to SAA, CRP, and IL-6 (p<0.05). ROC analysis revealed all variables tested had lower predictive performance for AKI prognosis. The average serum PCT level on day 28 (2.67 (0.89, 7.99) ng/ml) was significantly (p<0.0001) lower than on the day of AKI occurrence (43.71 (19.24,65.69) ng/ml) in survivors, but the serum PCT level on death (63.73 (34.22,94.30) ng/ml) was higher than on the day of AKI occurrence (37.55 (18.70,74.12) ng/ml) in non-survivors, although there was no significant difference between the two days in the latter group (p = 0.1365). CONCLUSION: Serum PCT is superior to CRP, IL-6, and SAA for predicting the development of AKI in patients with AP, and also can be used for dynamic evaluation of AKI prognosis.

Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection.

BACKGROUND: Procalcitonin (PCT) is an early, sensitive, and accurate marker for diagnosing infection and sepsis. As sepsis and septic shock are dominant causes of acute kidney injury (AKI), we investigated whether PCT is an early predictor of AKI in patients with symptoms of infection. METHODS: Between January 2011 and October 2011, 1361 inpatients in West China Hospital who displayed infection symptoms were enrolled in our study. Levels of PCT, serum amyloid A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and white blood cell count (WBC) were determined and participants' renal function was monitored for 3 consecutive days. RESULTS: The rate of AKI occurrence 3 days after enrollment was 14.6%. Higher PCT levels were correlated with higher AKI occurrence rates and higher levels of serum urea, creatinine, and cystatin C (p<0.05). The area under the receiver-operating characteristic (ROC) curve (AUC) for PCT was 0.823, making it more predictive (p<0.0001) than SAA, CRP, IL-6, or WBC. The cut-off value of 1.575 ng/mL for PCT had the highest validity for predicting AKI in patients with infection symptoms. The sensitivity, specificity, negative-predictive value (NPV), positive-predictive value (PPV), negative-likelihood ratio (LR-), and positive-likelihood ratio (LR+) for this cut-off value were 61.7%, 84.6%, 93.6%, 37.5%, 0.415, and 4.98, respectively. CONCLUSIONS: PCT can be used as a predictive marker for sepsis-induced acute kidney injury in patients with symptoms of infection.

Genetic variations in microRNA processing genes are associated with susceptibility in depression.

MicroRNAs (miRNAs) are new prominent gene expression regulators that have critical roles in neural development by regulating synaptic functions, and miRNA biogenesis may play an important role in psychiatric disorders. Despite emerging evidences demonstrating that single-nucleotide polymorphisms in the miRNA processing genes were associated with cancer and cardiovascular disorders, evidences about association between variants of the genes and depression are lacking. This study aims to find the association between miRNA processing gene variants and depression. We genotyped three polymorphisms from three miRNA processing genes in a case-control study including 314 patients and 252 matched healthy controls. The high-resolution melting method was used to genotype the three loci. Frequencies of genotypes and alleles showed significant difference between patients with depression and healthy controls in DGCR8 rs3757 and AGO1 rs636832. An allele frequency was significantly higher in rs3757 and lower in rs636832, respectively. Variant allele of DGCR8 rs3757 was associated with increased risk of suicidal tendency and improvement response to antidepressant treatment, whereas the variant of AGO1 rs636832 showed decreased risk of suicidal tendency, suicidal behavior, and recurrence. Besides allele frequency showed significant difference when compared patients with remission to controls, no significant differences were found in GEMIN4 rs7813 between patients and healthy controls. DGCR8 rs3757 and AGO1 rs636832 were found to have significant association with depression, and GEMIN4 rs7813 did not affect susceptibility to depression. These observations suggested that miRNA processing polymorphisms may affect depression risk and treatment.

Partial pressure of NH3 in cirrhotic patients with and without hepatic encephalopathy.

BACKGROUND AND AIMS: Although the exact pathogenetic factor in hepatic encephalopathy is still unknown, ammonia is considered to be the major cause of neurotoxicity. However, previous studies on the relationship between ammonia and the severity of hepatic encephalopathy have yielded variable results. Since unionized ammonia is the only form of ammonia that is able to freely spread through the blood-brain barrier and cause cerebral dysfunction, we tested the hypothesis that concentration of unionized ammonia is correlated with the severity of hepatic encephalopathy. METHODS: 156 patients with cirrhosis (74 with hepatic encephalopathy and 82 without) were enrolled, and underwent clinical examination and blood testing. Ammonia, pNH3 and pH determinations were repeated after two days of treatment. The differences in venous ammonia, pNH3, and pH among patients with and without encephalopathy were analyzed. RESULTS: Among cirrhotic patients with hepatic encephalopathy, pH, pNH3 and ammonia levels were all higher than those among patients without hepatic encephalopathy, and alkalosis was more common in patients with hepatic encephalopathy. Both venous ammonia and pNH3 were significantly correlated to the clinical grade of hepatic encephalopathy; however, the r was similar for venous ammonia (r=0.63) and pNH3 (r=0.68). The follow-up of 20 patients showed that the median levels of pH, pNH3 and venous ammonia decreased; venous ammonia levels were unchanged or higher in some patients after resolution of hepatic encephalopathy. CONCLUSION: This study supports that pH-dependant pNH3 and pH could be useful diagnostic and prognostic tools in cirrhotic patients with hepatic encephalopathy.

[Pathogenic effects of level of nitric oxide, hyponatremia and heart function on hepatorenal syndrome].

OBJECTIVE: To analyze the changes of liver function, renal function, electrolytes, heart function and serum nitric oxide (NO) in chronic severe hepatitis patients with hepatorenal syndrome (HRS) by plasma exchange (PE), study the relationship of NO, hyponatremia, heart function with HRS. METHODS: A total of 20 chronic severe hepatitis patients with HRS were recruited. All were treated thrice by PE. The parameters of blood pressure, heart rate, 24 h urinary volume, liver function indicators, renal function indicators, NO, cardiac troponin T (cTnT), brain natriuretic peptide (BNP), aldosterone, interleukin-6, tumor necrosis factor-α and plasma ammonia were measured before PE, during PE and after PE. Their differences were compared before, during and after PE. RESULTS: The NO level of HRS before PE was (113 ± 26) µmol/L, the level of Day 1 after PE (78 ± 24) µmol/L and the level of Day 3 after PE was (85 ± 29) µmol/L. All NO levels were lower than that before PE (all P < 0.05). Creatine level of HRS before PE was (191 ± 43) µmol/L and the level of Day 1 after PE (142 ± 42) µmol/L. All levels were lower than that before PE (all P < 0.05). The level of Day 3 after PE was 221 ± 105 µmol/L and it was higher than that before PE (P < 0.05). At pre-, during- and post-PE, the level of sodium was low than normal (normal range: 135 - 145 mmol/L), the level of aldosterone higher than normal (normal range: 10 - 27 ng/L), the level of cTnT higher than normal (normal range: < 14 ng/L) and the level of BNP higher than normal (normal range: < 366 ng/L). The levels of model for end-stage liver disease (MELD) score, bilirubin, urea, cysteine proteinase inhibitor C and ammonia decreased during PE, but increased post-PE. Systolic pressure and 24 h urinary volume decreased gradually. In this study, 8 patients died and 12 were discharged from hospital. CONCLUSION: Serum nitric oxide is not the sole occurring factor for hepatorenal syndrome. Hyponatremia and impaired heart function may be the key factors for hepatorenal syndrome.

[Study on levels of angiotensin converting enzyme and C-reactive protein in peripheral blood of mitral valve replacement preoperative patients with atrial fibrillation].

OBJECTIVE: To evaluate the levels of angiotensin converting enzyme and C-reactive protein in the peripheral blood of mitral valve replacement preoperative patients with atrial fibrillation (AF). METHODS: 24 atrial fibrillation patients, who were hospitalized for mitral valve replacement surgery, as study group (AF group) and 23 sinus rhythm patients as control group (SR group) were included in this study. The angiotensin converting enzyme and C-reactive protein in peripheral blood were quantified and compared in an attempt to find out whether the significant difference existed between the AF and SR groups. All patients undertook ultrasonic cardiography before operation. RESULTS: There was no significant difference in C-reactive protein between two groups (P > 0.05). The quantity of angiotensin converting enzyme in patients with AF was higher than that in patients with SR, which was statistically significant (P < 0.05). And also the left atrial dimension had a linear correlation with angiotensin converting enzyme. The obvious relation between angiotensin converting enzyme and left atrial dimension was seen in AF patients who need mitral valve replacement. CONCLUSIONS: This study demonstrates that the increase of the quantity of angiotensin converting enzyme in peripheral blood has relationship with atrial fibrillation of patients who need mitral valve replacement, and more research on the relations between AF and angiotensin converting enzyme would be needed.

[Contents of vitreous humor of dead body with different postmortem intervals].

OBJECTIVE: To establish regression correlations between postmortem interval (PMI) and contents of human vitreous humor of dead bodies for forensic purposes. METHODS: The human vitreous humor were taken from 126 dead bodies between 0.5 to 216 hours after death, and 11 chemical elements were detected by the OLYMPUS AU400 auto-biochemistry instrument. RESULTS: (1) The glucose, natrium and chlorine in human vitreous humor decreased, while the urea, creatinine, uric acid, potassium, calcium, magnesium, phosphorus, and micro-protein increased after death. The change of glucose, potassium and phosphorus were well correlated with the PMI (r = 0.824, 0.967, 0.880). But the uric acid and micro-protein did not have a good correlation with the PMI(r = 0.350, 0.153). (2) The stepwise regression analysis established the following equations for the PMI (Y): Y = -35. 15+6.05X, R2 = 0.957 (X = potassium); Y = -27.83+ 5.49X(1) - 1.35X(2), R2 = 0.960 (X(1) = potassium, X(2) = glucose); Y = -6.37+3.93X(1) -2.29X(2) + 5.36X(3), R2 = 0.966 (X(1) = potassium, X(2) = glucose, X(3) = phosphorus). CONCLUSIONS: (1) Eleven chemical components in human vitreous humor change after death, among which postassium has the best linear correlation with the PMI within 72 hours after death. (2) The accuracy of the estimation of PMI could be improved by establishing a multi-variable equation through stepwise regression.