Background: Sepsis has been redefined recently as life-threatening organ dysfunction caused by dysregulated host responses to infection and septic shock. Soluble urokinase plasminogen activator receptor (SuPAR) and plasminogen activator inhibitor-1(PAI-1) concentration positively correlate to the activation level of the immune system, and are markers of disease severity and aggressiveness. Objective: The study aimed to identify the blood level of plasminogen activator inhibitor-1 (PAI-1) and soluble urokinase plasminogen activator receptor (SuPAR) in sepsis and its association with mortality. Patient and methods: This is an observational prospective study that enrolled 60 adult patients with sepsis (according to SOFA), admitted to Menoufia and Zagazig university hospitals during the period from December 2019 till October 2020. Plasminogen activator inhibitor-1 (PAI-1) and soluble urokinase plasminogen activator receptor (SuPAR) were checked in all participants. Results: SuPAR and PAI.1 were significant independent predictors of hospital mortality. SuPAR showed sensitivity 100%, specificity 95.9%, and accuracy 94% for prediction of early mortality at a cutoff value of 13.4(pg/ml). While, PAI-1 demonstrated sensitivity 100%, specificity 93.9%, and accuracy of 95% at a cutoff value of 122.5 for predicting mortality. Conclusion: PAI-1 and suPAR were significant predictors of hospital mortality among sepsis patients. The sample size was relatively small, which may have decreased the statistical power of the results of the present study. Hence, additional studies with large sample sizes are required for further validation of the present results.
Background: Hemoglobin variability (HB), defined as hemoglobin value varying between low, normal and high levels, is a common condition among hemodialysis (HD) patients. Atherosclerotic lesions are highly prevalent in patients with chronic kidney disease (CKD). Carotid artery Intima-Media Thickness (CIMT) is noninvasive ultrasound test recommended to screen for heart disease. This work aimed to evaluate the relation between Hemoglobin variability and CIMT among the studied patients. Methods: A cross-sectional study was conducted on 70 patients on (HD) attending HD units in Internal Medicine Department in Zagazig University Hospitals and Al-Ahrar teaching hospital during the period from February 2018 to February 2019. Patients underwent history taking, clinical examination, and laboratory investigations. Efficiency of hemodialysis was calculated. CIMT is measured in B-mode ultrasound image using Doppler on carotid arteries. Results: A significant positive correlation is detected between hemoglobin change and both CIMT and total cholesterol. However, there is significant negative correlation between hemoglobin change and hematocrit level. A significant negative correlation is present between CIMT and hematocrit value, total protein and CRP. A significant positive correlation is present between CIMT and serum albumin, serum creatinine, BUN and total cholesterol. The best cutoff of hemoglobin variability in prediction of abnormal CIMT is ≥3.45, with sensitivity 86.7%, specificity 90.9%, positive predictive value 72.2%, negative predictive value 96.1% with accuracy 90% (p<0.001). Conclusion: Hemoglobin variability was associated with high CIMT in chronic HD patients. Hemoglobin variability ≥ 3.45, higher BUN, total cholesterol and CRP increase risk of abnormal CIMT.
IntroductionSepsis is a highly complex syndrome with highly heterogeneous clinical manifestations, which makes it difficult to detect and treat. Von Willebrand factor (vWF) functions differently depending on its multimeric size and adhesive properties, which are regulated by ADAMTS 13. Thus, a decrease in ADAMTS 13 activity results in the persistence of ultralarge vWF and the formation of microvascular thrombi, ischaemia, and organ failure. The aim of the study was to identify the role of von Willebrand factor antigen-to-ADAMTS 13 ratio in predicting early sepsis-related mortality.Material and methodsThis is a cohort of 70 sequentially selected adults with sepsis. The patients were classified into two groups: A (survivors) and B (non-survivors) based upon their survival within 7 days of hospital admission.ResultsVWF Ag, ADAMTS13, and vWF/ADAMTS13 ratio were significant predictors of early hospital mortality. For vWF Ag at a cut-off level of ≥ 3560 ng/l, sensitivity was 76% and specificity was 88.9%. For ADAMTS at a cut-off level of ≤ 210 ng/l, sensitivity was 84% and specificity was reported as 68.9%. For vWF/ADAMTS ratio at a cut off level of ≥ 17, sensitivity was 80% and specificity was 84.4%. There was a statistically highly significant positive correlation between non-survival and levels of vWF and vWF/ADAMTS 13 ratio, and there was a statistically highly significant negative correlation between non-survival and ADAMTS 13 level.ConclusionsHigh vWF/Ag and vWF/Ag/ADAMTS13 ratios on day 1 of admission are associated with increased early (7 days) sepsis-related mortality.
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