Tracking between cardiovascular-related measures at 4 and 8 years of age in the INMA-Asturias cohort.

Identifying cardiovascular-related measures that track from early childhood into later ages may help inform early prevention targets for cardiovascular disease. In this study, the tracking of triglycerides (TG), high-density cholesterol (HDL-c), atherogenic coefficient (AC), waist circumference to height ratio (WC/Height), mean arterial pressure (MAP), and homeostatic model assessment of insulin resistance (HOMA-IR) was examined in the INMA-Asturias cohort between 4 and 8 years of age. The analysis was conducted in 307 children who participated in the INMA-Asturias cohort (Spain) at 4 and at 8 years of age. Quantile regression models were used to evaluate tracking between measures at both ages, with each measure at 8 years as the dependent variable and the rank transformation of the same measure at 4 years as the independent variable. We found a positive association between HDL-c rank at 4 years and higher quantiles of the HDL-c distribution at 8 years, with an increase of 2.93 mg/dL (95% CI: 1.98, 3.87) per decile in the 0.9 quantile. A positive association was also found for WC/Height, with an increase of 0.008 (95% CI: 0.004, 0.012) per decile in the 0.9 quantile. We observed that tracking for AC increased in the higher quantiles of the distribution at 8 years, with an increase of 0.11 (95% CI: 0.09, 0.14) in the 0.6 quantile compared to an effect of 0.15 (95% CI: 0.09, 0.21) in the 0.9 quantile.  Conclusions: Adult markers of dyslipidemia and central obesity tracked between ages 4 and 8 years. For AC, tracking increased in the higher quantiles of the distribution. What is Known: • Atherosclerosis begins in early life, so preventive efforts that start in childhood may delay progression to clinical disease. Determine what cardiovascular risk factors track into time since childhood bring the opportunity to identified those subjects at risk for later cardiovascular disease. • The study of risk factors in health populations and, particularly in children, copes with not clear and/or controversial thresholds definition. This makes it challenging to study tracking in pediatric ages. What is New: • Quantile regression is a useful tool for assessing the tracking of risk factors for which there are no clinically meaningful thresholds. The increasing trend observed in the tracking of dyslipidemia suggests the possible difficulty that children with abnormal values at 4 years of age might have in normalizing them in future years. • The findings of this article may help to determine which cardiovascular-related measures could be screened and followed-up in children.

Cardiovascular risk factors and its patterns of change between 4 and 8 years of age in the INMA-Asturias cohort.

AIM: This study aimed to investigate whether there are subgroups of children with different clusters of cardiovascular disease (CVD) risk factors at 4 and 8 years of age, and their patterns of change between these two time points. METHODS: The analysis was conducted in 332 children who participated in the INMA-Asturias cohort (Spain) at 4 and at 8 years of age. The CVD risk factors were central obesity, dyslipidaemia, hyperglycaemia, and hypertension. Latent transition analysis was used to identify the different clusters and their probabilities of change. RESULTS: At 4 years, three subgroups were identified: no disorders (prevalence of 55.9%); some disorders (21.2%), and central obesity (22.9%). Three distinct subgroups were identified at 8 years: no disorders (59.8%); hypertension (17.9%), and central obesity (22.3%). Central obesity at 4 years tends to appear simultaneously with dyslipidaemia, while at 8 years it tends to appear simultaneously with dyslipidaemia and/or hypertension. Children aged 4 years with no disorders had a 93.7% probability of remaining in the same status at 8 years of age. Children aged 4 who had some disorders had a 67.7% of probability of having only hypertension and a 32.3% of probability of having central obesity. Children aged 4 in the central obesity subgroup had a 32.4% of probability of having no disorders at 8 years of age, while 67.6% still had central obesity. CONCLUSIONS: These exploratory findings suggest that children who do not present any disorder at 4 years of age tend to remain in that state at 8 years of age. And also that central obesity may play a major role in the development of other disorders, as the number of disorders with which it concomitantly occurs increases between the ages of 4 and 8 years.

Estrategias alternativas al uso de la hemoglobina glicosilada en la monitorización del estado glucémico de los pacientes diabéticos con enfermedad renal crónica terminal / Alternative strategies to the use of glycosylated hemoglobin in monitoring the glycemic status of diabetic patients with end-stage renal disease

Introducción: La diabetes mellitus (DM) es una de las principales causas de enfermedad renal crónica terminal. Un óptimo control glucémico es básico para prevenir las comorbilidades asociadas a la enfermedad, siendo la hemoglobina glicosilada (HbA1c) el marcador glucémico recomendado. No obstante, en pacientes en hemodiálisis (HD) este marcador presenta importantes limitaciones, lo que ha llevado a buscar marcadores alternativos como albúmina glicosilada (AG), fracción lábil de la hemoglobina glicosilada (LHbA1c) o índices de glicación.Pacientes y métodosSe reclutaron 47 pacientes en HD, 23 con DM, obteniéndose muestras para la determinación de AG, HbA1c y LHbA1c. Los índices de glicación, que permiten estimar el valor de HbA1c mediante glucosa, AG o LHbA1c, se calcularon incluyendo un grupo control compuesto por 75 pacientes diabéticos sin enfermedad renal.ResultadosLos pacientes diabéticos en HD presentaron valores medios significativamente mayores que los pacientes sin DM para glucosa [160 (44) vs. 96 (12) mg/dL], HbA1c [6,4 (1,0) vs. 4,9 (0,3)%], AG [16,0 (5,1) vs. 12,9 (1,6)%] y LHbA1c [2,0 (0,3) vs. 1,7 (0,2)%].La HbA1c calculada mediante los índices de glicación fue significativamente superior a la medida en todos los pacientes en HD, indistintamente del marcador empleado para su estimación.ConclusionesLos marcadores glucémicos evaluados (glucosa, AG y LHbA1c) parecen reflejar una posible subestimación del estado glucémico real por la HbA1c debido a las limitaciones que presenta en los pacientes en HD. El uso de marcadores alternativos, teniendo en cuenta también sus limitaciones, podría mejorar el seguimiento de los pacientes en HD y disminuir, por tanto, el riesgo del desarrollo de complicaciones asociadas a DM2. (AU)

Background:Diabetes mellitus (DM) is one of the leading causes of end-stage renal disease. Glycosylated hemoglobin (HbA1c) is the recommended glycemic marker to achieve an optimal glycemic control that is essential to prevent comorbidities associated with the disease. However, in patients on haemodialysis (HD) this marker has important limitations, this reason has led us to search alternative markers such as glycosylated albumin (AG), labile fraction of glycosylated hemoglobin (LHbA1c) or glycation indices.Patients and methodsWe enrolled 47 patients in HD, 23 with DM, obtaining samples for the determination of de AG, HbA1c y LHbA1c. Glycation indices, which allow estimated the HbA1c using glucose, AG or LHbA1c, were calculated including a control group composed of 75 diabetic patients without kidney disease.ResultsDiabetic patients in HD had significantly higher mean values than patients without DM for glucose [160 (44) vs 96 (12)mg/dL], HbA1c [6,4 (1,0) vs 4,9 (0,3)%], AG [16,0 (5,1) vs 12,9 (1,6)%] and LHbA1c [2,0 (0,3) vs 1,7 (0,2)%].HbA1c calculated using glycation indices was significantly higher than measured in all HD patients, regardless of the marker used for the estimation.ConclusionsThe glycemic markers evaluated (glucose, AG and LHbA1c), could reflect a possible underestimation of the real glycemic state by HbA1c because of the limitations of this marker in HD patients. The use of alternative markers, knowing their limitations, could improve the monitoring of patients on HD and, therefore, reduce the risk of developing DM2 complications. (AU)

[Alternative strategies to the use of glycosylated hemoglobin in monitoring the glycemic status of diabetic patients with end-stage renal disease]. / Estrategias alternativas al uso de la hemoglobina glicosilada en la monitorización del estado glucémico de los pacientes diabéticos con enfermedad renal crónica terminal.

BACKGROUND: Diabetes mellitus (DM) is one of the leading causes of end-stage renal disease. Glycosylated hemoglobin (HbA1c) is the recommended glycemic marker to achieve an optimal glycemic control that is essential to prevent comorbidities associated with the disease. However, in patients on haemodialysis (HD) this marker has important limitations, this reason has led us to search alternative markers such as glycosylated albumin (AG), labile fraction of glycosylated hemoglobin (LHbA1c) or glycation indices. PATIENTS AND METHODS: We enrolled 47 patients in HD, 23 with DM, obtaining samples for the determination of de AG, HbA1c y LHbA1c. Glycation indices, which allow estimated the HbA1c using glucose, AG or LHbA1c, were calculated including a control group composed of 75 diabetic patients without kidney disease. RESULTS: Diabetic patients in HD had significantly higher mean values than patients without DM for glucose [160 (44) vs 96 (12)mg/dL], HbA1c [6,4 (1,0) vs 4,9 (0,3)%], AG [16,0 (5,1) vs 12,9 (1,6)%] and LHbA1c [2,0 (0,3) vs 1,7 (0,2)%]. HbA1c calculated using glycation indices was significantly higher than measured in all HD patients, regardless of the marker used for the estimation. CONCLUSIONS: The glycemic markers evaluated (glucose, AG and LHbA1c), could reflect a possible underestimation of the real glycemic state by HbA1c because of the limitations of this marker in HD patients. The use of alternative markers, knowing their limitations, could improve the monitoring of patients on HD and, therefore, reduce the risk of developing DM2 complications.

Recomendaciones para la elaboración de un cuadro de mando integral para la gestión de pruebas en el lugar de asistencia del paciente (POCT). Recomendación (2017) / Recommendations for constructing a balanced scorecard for point-of-care testing (POCT) management. Recommendation (2017)

El avance tecnológico en el campo del diagnóstico clínico ha generado una diversidad de pruebas de laboratorio aplicables en el lugar de asistencia al paciente (POCT), y ha permitido contar con una mayor calidad analítica de los procedimientos implementados. La elaboración de un cuadro de mando integral es una herramienta útil para el éxito en la gestión de un proceso trasversal, complejo e interdisciplinario, como es el de obtener resultados analíticos fiables, transferibles de forma inmediata mediante sistemas POCT. Para la elaboración de un cuadro de mando integral se deben considerar cuatro perspectivas: la de los clientes (pacientes, médicos, grupos de interés), la financiera (inversores privados o públicos), la de los procesos operativos internos (sistemas, procesos) y la de los profesionales (cultura organizativa). El objeto de este documento es establecer recomendaciones para la elaboración de un cuadro de mando integral para gestionar los sistemas POCT disponibles en una institución

Technological development of in vitro diagnostics has led to a diversity of new tests for point-of-care testing (POCT) and at the same time provides quality in the process. Construction of a balanced scorecard is a useful tool for the success in the management of a cross-sectional, complex and interdisciplinary process, as well as to obtain reliable analytical results for immediately use with POCT systems. In constructing a balanced scorecard, four perspectives should be considered: Customer (patients, doctors), Financial (private or public investors), Operating procedures (systems, processes), and Professionals (organisational culture). The aim of this document is to establish the recommendations for the development of an adequate balanced scorecard to manage a point-of-care network in a healthcare system

Assessment of patient safety culture in clinical laboratories in the Spanish National Health System.

INTRODUCTION: There is increasing awareness of the importance of transforming organisational culture in order to raise safety standards. This paper describes the results obtained from an evaluation of patient safety culture in a sample of clinical laboratories in public hospitals in the Spanish National Health System. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted among health workers employed in the clinical laboratories of 27 public hospitals in 2012. The participants were recruited by the heads of service at each of the participating centers. Stratified analyses were performed to assess the mean score, standardized to a base of 100, of the six survey factors, together with the overall patient safety score. RESULTS: 740 completed questionnaires were received (88% of the 840 issued). The highest standardized scores were obtained in Area 1 (individual, social and cultural) with a mean value of 77 (95%CI: 76-78), and the lowest ones, in Area 3 (equipment and resources), with a mean value of 58 (95%CI: 57-59). In all areas, a greater perception of patient safety was reported by the heads of service than by other staff. CONCLUSIONS: We present the first multicentre study to evaluate the culture of clinical safety in public hospital laboratories in Spain. The results obtained evidence a culture in which high regard is paid to safety, probably due to the pattern of continuous quality improvement. Nevertheless, much remains to be done, as reflected by the weaknesses detected, which identify areas and strategies for improvement.

Variación biológica de lípidos y lipoproteínas séricas en individuos sanos y pacientes con enfermedad renal crónica terminal / Biological variation of serum lipids and lipoproteins in healthy individuals and in end-stage renal disease patients

Introducción. Las enfermedades cardiovasculares constituyen una de las principales causas de morbimortalidad tanto en la población general como en pacientes con enfermedad renal crónica terminal (ERCT), siendo las dislipemias uno de los principales factores de riesgo asociados. Una correcta interpretación del perfil lipídico solo puede realizarse teniendo en cuenta su variación biológica. Se han estimado los datos de variación biológica de los lípidos y lipoproteínas séricas en individuos sanos y en pacientes con ERCT y, a partir de ellos, calculado el valor de referencia del cambio (VRC), el índice de individualidad y las especificaciones de calidad deseables. Material y métodos. Se obtuvieron muestras de suero de 18 pacientes con ERCT, mensualmente durante un periodo de 6 meses, y de 11 sujetos aparentemente sanos, una vez por semana durante 5 semanas consecutivas. La estimación de los datos de BV se realizó mediante un análisis de la varianza (ANOVA). Resultados. Las concentraciones de triglicéridos y colesterol VLDL eran significativamente mayores en pacientes con ERCT que en individuos sanos, mientras que la concentración de colesterol HDL era significativamente menor. Sin embargo, no se observaron diferencias significativas en los componentes de variación biológica y, en consecuencia, las estimaciones del índice de individualidad, los VRC y las especificaciones de calidad analítica fueron semejantes. Conclusiones. Los VRC derivados de individuos sanos son adecuados para el seguimiento de la dislipemia en pacientes con ERCT. Unos VRC asimétricos, consecuentes con la distribución no gausiana de las concentraciones observadas en ambos grupos, permitirían evaluar de una forma más exacta la respuesta al tratamiento hipolipemiante en individuos dislipémicos (AU)

Introduction. Cardiovascular diseases are a major cause of morbidity and mortality in both the general population and in patients with end stage renal disease (ESRD), with dyslipidemia being the one of the main associated risk factors. A correct interpretation of the lipid profile can only be made when the within- and between-subject biological variation is taken into account. In this study the biological variation data has been estimated for serum lipids and lipoproteins in healthy individuals and ESRD patients, and these data were then used to define the reference value change (RVC), the index of individuality, and the analytical goals. Material and methods. Serum samples were collected from 18 ESRD patients in steady-state conditions, one per month during 6 months, and from 11 healthy volunteers at weekly intervals over 5 weeks. Biological variation data were derived using ANOVA. Results. Triglycerides and VLDL cholesterol concentrations were significantly higher in ESRD patients than in healthy individuals, whereas HDL cholesterol concentration was significantly lower. However, no differences were observed in the biological variation data and, consequently, the derived RVCs, index of individualiy and analytical goals were similar. Conclusions. The use of the RVC derived from healthy individuals is appropriate in the monitoring of dyslipidemia in ESRD patients. Asymmetric RVC, according to the non-Gaussian distribution of serum concentrations in both groups, would enable the response to the hypolipemiant treatment in dyslipidemic individuals to be assessed more accuratel (AU)

Valor de referencia del cambio del PSA en la evaluación del riesgo de cáncer de próstata / Reference change value for PSA and its application in prostate cancer risk management

Introducción. Únicamente el 25-30% de los pacientes sometidos a biopsia prostática por un antígeno prostático específico (PSA) sérico elevado padecen cáncer de próstata (CP). La consideración de la variación biológica del PSA en la interpretación de los resultados, mediante el valor de referencia del cambio (VRC), puede ser una herramienta eficaz para mejorar la selección de pacientes candidatos a este procedimiento invasivo. Se ha estudiado su utilidad para establecer la significación clínica de los incrementos anuales del PSA y se ha evaluado la capacidad diagnóstica combinada del VRC, la velocidad de crecimiento de PSA (VcPSA), la densidad de PSA (dPSA) y el cociente PSA libre/PSA total (IPSA). Material y métodos. Se realizó un estudio retrospectivo en 69 pacientes que presentaban VcPSA>0,75 ng/mL/año y estudio anatomopatológico tras biopsia, 15 de ellos con diagnóstico de CP, recopilándose también los valores de IPSA y dPSA. El VRC del PSA se estimó a partir de los datos de variación de biológica recogidos en las bases de datos internacionales. Resultados. Con una imprecisión de 3,4%, el VRC obtenido para el PSA total fue de 42%, con el que se reevaluaron los incrementos anuales observados. Con este valor discriminante solo 16 (23,2%) pacientes habrían sido biopsiados, 7 de ellos con diagnóstico de CP, duplicando el valor predictivo positivo (VPP) de la prueba. La utilización conjunta de todos los parámetros calculados demostró un incremento notable del VPP de la prueba. Conclusiones. El empleo del VRC del PSA como valor de decisión clínica podría reducir sustancialmente el número de biopsias innecesarias (AU)

Introduction. Only 25-30% of patients undergoing prostate biopsy due to an abnormal serum prostate specific antigen (PSA) suffer from prostate cancer (PC). The consideration of PSA biological variation, using the reference change value (RCV), in the interpretation of laboratory values can be an effective tool to identify candidate patients for this invasive procedure. The aim of the study was to establish the usefulness of the RCV to assess the clinical significance of annual PSA increases and evaluate the combined diagnostic capacity of RCV, PSA velocity (VPSA), PSA density (DPSA) and ratio of free PSA/total PSA (PSAI). Material and methods. We performed a retrospective study in 69 patients with VcPSA>0.75 ng/mL/year and histopathological studies after prostate biopsy, 15 of them with PC diagnosis. IPSA and PSAd values for those subjects were also collected. RCV for PSA was calculated from the biological variation data collected from international databases. Results. With a 3.4% analytical imprecision, the RCV for total PSA was 42% and this cut-off was used in the assessment of the annual PSA increase. Only 16 (23.2%) patients would have undergone biopsy, 7 of them with PC diagnosis, which doubles the positive predictive value (PPV) of the test. Further increases of PPV could be shown with the combined assessment of all derived parameters. Conclusions. The use of RCV for PSA as the value of clinical decision could substantially reduce the number of unnecessary biopsies (AU)

The concentrations of soluble vascular cell adhesion molecule-1 and lipids are independently associated with venous thromboembolism.

BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE) involves inflammation and a relation with dyslipidemia which remains controversial. The vascular cell adhesion molecule-1 (VCAM-1) is a ligand expressed by activated endothelium (and recruits leukocytes) whose soluble form (sVCAM-1) increases in atherosclerosis, severe hypertriglyceridemia or deep vein thrombosis (DVT) in acute phase. We analyzed the association between VTE (> 6 months after), sVCAM-1 and lipid concentrations. DESIGN AND METHODS: Case-control study involving 126 consecutive patients (aged 25-80 years, 49% males) and 125 controls of similar age and gender. RESULTS: The patients had a more unfavorable lipid profile than controls [higher triglycerides (p<0.001), LDLc/HDLc ratio (p<0.01) or total cholesterol (TC) (p=0.07)] and higher sVCAM-1 concentration (p<0.01) even adjusting for arterial diseases. VTE was associated with extreme values of TC, LDL-c, triglycerides (>P90) and HDL-c (P90) (OR=4.2)(p<0.0001). The sVCAM-1 values were age-related (r=0.26, p<0.001) but independent of lipid levels. Hazards ratios from five-fold to ten-fold appeared when combining the sVCAM-1 top quartile (>970 ng/mL) with TC >250 mg/dL or HDL-c <45 mg/dL (p<0.01) irrespective of thrombophilic status. Recurrent or severe VTE cases (pulmonary embolism or proximal DVT vs. distal DVT) showed higher sVCAM-1 values (p<0.05). All the associations weakened among females. In stepwise logistic regression, obesity (p<0.001), sVCAM-1 (p<0.001) and LDL-c (p=0.004) in men and sVCAM-1 (p=0.02) and triglycerides (p=0.04) in women retained their independent association. INTERPRETATION AND CONCLUSIONS: Although the exact mechanisms linking abnormal lipid and sVCAM-1 concentrations to VTE await clarification, both seem to be independently associated.

Concentración sérica de cortisol en tres franjas horarias en pacientes con enfermedad aguda no crítica / Serum cortisol concentrations in acute non-critical ill patients, measured in three periods of the day

FUNDAMENTO: Análisis de la cortisolemia en pacientes sin insuficiencia corticosuprarrenal con enfermedad aguda no crítica, en tres franjas horarias del nictémero (11:30-15:00 h; 15:0018:30 h; 18:30-22:00 h). PACIENTES Y MÉTODO: Se seleccionó a 113 pacientes (40, 38 y 35, respectivamente) cuyo diagnóstico pudo establecerse con certeza en el servicio de urgencias. RESULTADOS: Las cortisolemias mínima y media de cada franja fueron respectivamente: 8-8-8 µg/dl (220,8-220,8-220,8 nmol/l) y 27,824,1-29,3 µg/dl (767,3-665,2-808,7 nmol/l) sin diferencias significativas entre estas últimas. La cuarta parte de los pacientes no alcanzó cortisolemias 18 µg/dl (496,8 nmol/l). CONCLUSIONES: Cortisolemias al azar inferiores a 8 µg/dl (220,8 nmol/l) durante una enfermedad aguda son muy indicativas de insuficiencia suprarrenal (AU)