Procalcitonin and BISAP score versus C-reactive protein and APACHE II score in early assessment of severity and outcome of acute pancreatitis.

BACKGROUND/AIM: Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the value of procalcitonin (PCT) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as C-reactive protein (CRP) and Acute Physiology and Chronic Health Evaluation (APACHE) II score. METHODS: This prospective study included 51 patients (29 with severe AP). In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease. RESULTS: Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significantly elevated in patients with severe form of the disease. In predicting severity of AP at 24 h of admission, sensitivity and specificity of the BISAP score were 74% and 59%, respectively, APACHE II score 89% and 69%, respectively, CRP 75% and 86%, respectively, and PCT 86% and 63%, respectively. It was found that PCT is highly significant predictor of the disease outcome (p < 0,001). CONCLUSION: In early assessment of AP severity, PCT has better predictive value than CRP, and similar to the APACHE II score. APACHE II score is a stronger predictor of the disease severity than BISAP score. PCT is a good predictor of AP outcome.

Relation between 25(OH)-vitamin D deficiency and markers of bone formation and resorption in haemodialysis patients.

Deficient serum 25-hydroxyvitamin D [25(OH)D] may contribute to the impaired bone turnover of end stage renal disease patients. In 112 hemodialysed patients we analysed the relation between 25(OH)D and bone alkaline phosphatase (BALP), beta-CrossLaps (beta-CTx) and iPTH. We analysed parameters according to the manufacturers' instructions. We found potentially significant vitamin D deficiency: 71% of patients had 25(OH)D levels below 50 nmol/L. In patients with iPTH below 150 pg/mL (n = 57), we observed significantly low 25(OH) (p < 0.01). In addition, patients with iPTH above 300 pg/mL had higher BALP levels (p < 0.05). There were negative correlations between serum 25(OH)D and both BALP and iPTH (r = -0.225, p < 0.05 and r = -0.331, p < 0.05). Beta-CTx levels were significantly higher in patients who did not receive vitamin D supplementation (p < 0.01). In addition, reduced BALP and iPTH levels indicate decreased bone turnover. Recorded data could signify that vitamin D deficiency may contribute to the impaired bone metabolism of hemodialysis patients.

[Comparative analysis of the efficacy and biocompatibility of various methods of dialysis].

BACKGROUND/AIM: The efficacy and biocompatibility of hemodialysis have a singnificant impact on dialysis patient morbidity and mortality rate. The aim of our study was to compare the efficacy and biocompatibility of different hemodialysis modalities in our patients. METHODS: A total of 55 patients were included in the study, and on the basis of dialysis modality, they were divided in four groups: group I--post-dilution on-line hemodiafiltration (n=15), group II--bicarbonate high-flux polysulphone hemodialysis (n=15), group III--bicarbonate low-flux polysulphone hemodialysis (n=15), and groupe IV--bicarbonate cuprophane hemodialysis (n=10). The efficacy was evaluated on the basis of urea reduction rate (URR), urea Kt/V index and serum beta2-microglobuline reduction rate, and the biocompatibility was evaluated on the basis of the leukocyte count fall during the first fiftheen minutes of dialysis session, and of the serum C-reactive protein (CRP) level. RESULTS: The highest mean URR was achieved in the group I (70.53 +/- 6.49%), and it was significantly higher in comparison with the average URR in the group IV (54.8 +/- 6.35%) (p = 0.001). The average value of urea Kt/V index in the group I (1.48 +/- 0.22) was significantly higher in comparison with the average value in the group II 1.30 +/- 0.22 (p < 0.05), group III (1.05 +/- 0.22), and group IV (0.98 + 0.22) (p = 0.001). Serum beta2-microglobuline reduction rate was 68.93 +/- 8.25% in the group I, and 58.86 +/- 7.98% in the groupe II (p = 0.01). During the first 15 minutes of hemodialysis the leukocyte number was decreased by 12.57 +/- 9.35% in the group 1, 13.61 +/- 9.64% in the group 11, 18.3 +/- 13.24 in the group III and 62.3 +/- 15.4 in the group IV, on average. The mean serum level of CRP was 9.4 +/- 6.47 mg/l in the group IV, and less than 3.5 mg/l in the group I of the patients (p = 0.001). CONCLUSION: Postdilution on-line hemodiafiltration in comparison with standard hemodialysis provided the more effective elimination of small and middle uremic toxins molecules and a significantly higher degree of biocompatibility. The patients treated with standard hemodialysis frequently do not achieve the minimal value of urea Kt/V index prescribed by National Kidney Foundation-Dialysis Outcomes Quality Inatiatives standards. These patients also have significantly higher serum CRP values which suggest the state of chronic microinflammation.

Apolipoprotein(a) gene polymorphisms (TTTTA)n and G/A-914 affect Lp(a) levels in ischemic heart disease patients from Serbia.

OBJECTIVES: Lipoprotein(a) (Lp(a)) concentration is determined primarily by the apolipoprotein(a) (apo(a)) gene. The pentanucleotide (TTTTA)n repeat and G/A-914 polymorphisms are in the 5' promoter region of the apo(a) gene. To elucidate whether these polymorphisms affect Lp(a) levels, a total of 211 Serbian adults were investigated. DESIGN: One hundred and eleven patients with ischemic heart disease and 100 healthy controls were genotyped and Lp(a) levels determined. RESULTS: Lp(a) concentrations differed according to the (TTTTA)n genotypes: among those having at least one allele 8, patients had significantly higher Lp(a) values than controls. A decreasing trend of Lp(a) values was associated with the -914A allele in controls but the opposite was true in patients. Patients with genotype TTTTA allele 8/AA-914 had significantly higher Lp(a) values than those without allele 8/AA (p < 0.05). The >8>8/GG genotype was not detected. Significant linkage disequilibrium between (TTTTA)n and G/A-914 polymorphism (p < 0.001) was found. In multivariate regression analysis, the G/A-914 polymorphism significantly (p < 0.05) affected Lp(a) levels in patients, after taking into account the (TTTTA)n polymorphism. CONCLUSION: These results indicate that (TTTTA)n and G/A-914 polymorphisms affect Lp(a) levels in ischemic heart disease as a consequence of the linkage disequlibrium.

[Efficacy of valsartan in the treatment of persistent microalbuminuria in normotensive patients with type 1 diabetes]. / Efikasnost valsartana u terapiji perzistentne mikroalbuminurije kod normotenzivnih bolesnika sa tipom 1 secerne bolesti.

AIM: To determine the efficacy of AT1 receptor antagonist (valsartan) in decreasing of urinary excretion of albumin in normotensive patients with type 1 diabetes and incipient diabetic nephropathy (DN). METHODS: This was a prospective, randomised, placebo-controlled study, which included 20 patients with insulin-dependent diabetes mellitus, mean age 25.15, and the duration of diabetes of 13.95 years. All the patients were normotensive, with persistent microalbuminuria (incipient phase of DN). Patients were randomly divided into two groups (10 patients each): valsartan group treated with 80 mg valsartan daily during 6 months, and the group treated with placebo during the same period. Both groups were similar and comparable concerning the observed parameters at the beginning of the study. RESULTS: After 6 months therapy, valsartan caused significant decrease of urinary albumin excretion rate (UEAR) by 69.1% from 64.8 to 21.1 mg/24 h, while in placebo group there was an insignificant increase of UEAR by 29.8%. During the follow-up of UEA in the observed groups, at the beginning and the end of the mentioned period, highly significant decrease of albumine secretion (p < 0.001) was observed. Valsartan significantly lowered mean systolic blood pressure (from 122.0 +/- 10.1 to 110.0 +/- 11.8 mmHg). After 6 months therapy, the reduced values of total cholesterol and LDL-cholesterol fraction were registered in the valsartan group, while the difference in serum triglyceride values reached statistical significance (1.42 +/- 0.79 vs. 1.21 +/- 0.89 mmol/L; p < 0.05). Neither significant difference in glycoregulation quality between the two groups, nor the occurrence of hyperkalemia was detected throughout the study period. CONCLUSION: Valsartan's efficacy in the decrease of microalbuminuria after 6 months of therapy could justify the use of this group of renin/angiotensin blockers in delaying the clinically manifested DN. Valsartan was well tolerated and did not influence the quality of glycoregulation. It did not increase the level of serum lipids and could be recommended in the treatment of diabetic patients.