The value of urine albumin in predicting thromboembolic events for patients with non-valvular atrial fibrillation.

BACKGROUND: Accurate risk stratification is important in the management of patients with non-valvular atrial fibrillation (NVAF). However, one cohort study demonstrated an annual ischemic stroke rate of 1.61% in the group of patients classified in "the true low risk" according to CHA2DS2-VASc. We aimed to find out more indicators and evaluate their abilities in predicting thromboembolic events (TE). METHODS: We assigned 58 patients with TE to the thrombosis group, and 157 patients without TE to the non-thrombosis group. The clinical parameters of these patients were subjected to univariate analysis and unconditioned logistic regression analysis for screening the risk factor, which was urine albumin (UA) according to the result. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point of the UA. Then we formed the CHA2DS2-VASc-UA2 score and made a comparison with CHA2DS2-VASc score. RESULTS: Mean UA of the thrombosis group was significantly higher than that of the non-thrombosis group (0.1g/L vs 0.0g/L, P<0.01). The results of unconditioned logistic regression analysis showed that OR of UA was 40.98 (95% CI: 3.58-468.88, P<0.01). The Area Under the Curve (AUC) of UA was 0.700 with an optimal cut-off point of 0.03g/L. ROC curve analysis result showed that AUC of CHA2DS2-VASc-UA2 score was larger than that of CHA2DS2-VASc score (0.873 vs 0.860, P<0.01). CONCLUSION: UA≥0.03g/L is the independent predictive factor of TE for NVAF patients. And the CHA2DS2-VASc-UA2 score might perform better in predicting TE compared with the CHA2DS2-VASc score.

Primary focal segmental glomerulosclerosis in nephrotic patients: common complications and risk factors.

BACKGROUND: Focal segmental glomerulosclerosis (FSGS) presents a range of potentially serious complications, including acute kidney injury (AKI), infection and thromboembolism. This study aimed to find out the incidence rates and risk factors for these complications in FSGS patients. METHODS: Patients with biopsy-proven primary FSGS and nephrotic-range proteinuria were included in this study. A short-term (16-week) follow-up was performed to observe the aforementioned complications. Clinical characteristics of patients were recorded upon enrollment. AKI was diagnosed as an absolute increase in serum creatinine of ≥0.3 mg/dL or a percentage increase of ≥50% within 48 hours; infection, by a combination of clinical manifestations, laboratory tests and imaging examinations; and thromboembolism, by imaging methods. Risk factors for complications were evaluated by logistic regression model. RESULTS: The study population included 90 FSGS patients (63 males, mean age 28.9 ± 12.9 years). The incidences of AKI, infection and thromboembolism were 44.4%, 25.6% and 12.2%, respectively. Patients with AKI were more likely to be male, with lower serum albumin, greater proteinuria and more severe acute tubulointerstitial damage. Patients with infection had higher proteinuria and lower serum albumin, globulin and IgG. Circulating endothelial cells (CECs) and von Willebrand factor were higher in patients with thromboembolism. Logistic regression showed that increased urine retinol-binding protein, decreased serum albumin and IgG, and increased CECs and hemoglobin were independent risk factors for AKI, infection and thromboembolism, respectively. CONCLUSIONS: AKI, infection and thromboembolism are common among FSGS patients. Awareness of risk factors and prevention of these complications are important for the prognosis of these patients.

Screening for aspirin resistance in stable coronary artery patients by three different tests.

BACKGROUND: Aspirin (ASA) failure to inhibit in vitro platelet function had been termed ASA resistance. The prevalence of this phenomenon as measured with different platelet function tests varies widely among studies. OBJECTIVES: In this study, we propose to determine the prevalence of ASA non-responsiveness in stable coronary artery patients using three different tests. PATIENTS AND METHODS: One hundred ninety-one patients with a stable coronary artery disease and receiving secondary ASA prophylaxis (250 mg/day) were tested. For each patient the ASA-induced platelet inhibition was determined using three different tests: Ivy Bleeding time (BT), collagen/epinephrine closure time (CEPI-CT; PFA-100, Dade-Behring) and urinary 11-dehydrothromboxane B2 (uTxB2) excretion level. The agreement between these tests was evaluated by kappa statistics test. RESULTS: The prevalence of biological ASA resistance was 15.7% (n=30), 20.4% (n=39) and 24.6% (n=47) by BT, PFA-100 and UTxB2, respectively. Only fourteen patients (7.3%) were non-responders for two tests: 6 (3.1%) BT/ PFA-100; 1 (0.5%) BT/UTxB2; 7 (3.7%) PFA-100/UTxB2). A poor agreement was found between these three methods and only 3 patients were resistant with all the tests (1.6%). CONCLUSION: The lack of agreement supposed that different types of aspirin resistance exist. Thus, combination of two tests or more could be a primary solution for a better identification of ASA resistant patients. This hypothesis must be confirmed by a large-scale randomized study with clinically well-defined endpoints.

[Plasma and urinary fibrin fibrinogen degradation products in a case of renal thromboembolism]. / Prodotti di degradazione della fibrina-fibrinogeno plasmatici ed urinari in un caso di tromboembolia renale.

The authors examined the trend of plasma (FDPp) and urine (FDPu) fibrin-fibrinogen degradation products in a case of renal thromboembolism during atrial fibrillation. No alterations of FDP are reported in the literature for this renal pathology. This raises the question of whether this laboratory parameter is of diagnostic value during the course of renal embolism. The case concerned a patient who was admitted to the emergency ward with painful symptoms in his right flank. He was initially hospitalised with a diagnosis of right renal colic. A few days later multiple thromboembolism of the right kidney was diagnosed using CAT with i.v. infusion of contrast medium and renal scintigraphy with 99Tc DTPA. From day 6 to day 17 after the start of painful symptoms, a number of assays were made of FDPp and FDPu using the rapid latex test for FDP which uses specific anti-fragment D and E antiserum (Thrombo-Wellcotester). Alterations of plasma and urine FDP were found which also showed an opposite trend: an inversion of the changes was noted on day 8 with normalisation of FDPp and a persistent increase in FDPu by day 17. Earlier tests may confirm the trend of FDP and their value in diagnostic screening for cases of renal thromboembolism.

[Proteins C and S of coagulation: new markers of thrombotic risk in nephrotic syndromes?]. / Protéines C et S de la coagulation: des nouveaux marqueurs du risque thrombotique au cours des syndromes néphrotiques?

Thromboembolic events remain one of the most serious complications in patients with nephrotic syndrome (NS). The natural anticoagulant system protein C-protein S was evaluated in patients with proteinuria and NS. Protein C levels were found to be normal or increased in NS. Protein C levels correlated positively with proteinuria, cholesterol and triglycerides and negatively with serum albumin. All of the 17 patients with NS exhibited urinary loss of protein C. Total protein S and C4BP were increased in mild and moderate forms of NS. Free protein S was identical in controls and NS patients. Nine of ten patients had urinary loss of protein S. No correlation was found between protein S and the various usual biologic parameters of NS. However, two patients with NS and thrombosis of the renal veins had an acquired deficit in either free protein S or protein C. Thus, in some patients, an acquired deficit in free protein S and/or protein C may contribute to the development of thrombotic complications in NS.