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Huang S, Guo Y, Chen L, Wang Y, Chen X. Clinical muscle mass-related biomarkers that predict mortality in older patients with community-acquired pneumonia. BMC Geriatr 2022; 22:880. [PMCID: PMC9675073 DOI: 10.1186/s12877-022-03626-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Community-acquired pneumonia (CAP) is associated with elevated morbidity and mortality, and it usually occurs in older adults. Our goal here was to assess the efficacies of muscle mass-related biomarkers, such as, aspartate transaminase/alanine transaminase (AST/ALT) and creatinine/cystatin C*100 (Cr/CysC*100), in predicting 1-, 2-, and 3-year mortalities of older CAP patients. Methods Design: Retrospective cohort study. Setting and Participants: A teaching hospital in western China. Hospitalized CAP patients, aged≥60 years. We separated patients into a high or low muscle mass group, according to the median AST/ALT and Cr/CysC*100, respectively. We acquired data from medical records and local government mortality databases, as well as telephonic interviews. We analyzed the association between low muscle mass (AST/ALT and Cr/CysC*100) and all-cause mortality at 1, 2, and 3 years in older patients with CAP. Results We enrolled 606 patients (58.58% male; median age: 81 years) for analysis. The 1-, 2-, and 3-year mortality in older patients with CAP in the low muscle mass group (AST/ALT) was higher than in the high muscle mass group (AST/ALT) (1-year: 51.16% vs. 36.96%, p < 0.001; 2-year: 54.46% vs. 41.25%, p = 0.001; 3-year: 54.79% vs. 42.9%, p = 0.003). Upon adjustment of potential confounding factors, we revealed, using cox regression analysis, that the low muscle mass group (AST/ALT) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow-ups, compared to the high muscle mass group (AST/ALT) (1-year: hazard ratios (HR) = 1.46, 95% confidence interval (CI): 1.13–1.88; 2-year: HR = 1.39, 95% CI: 1.09–1.77; 3-year: HR = 1.35, 95% CI: 1.06–1.72). The 1-, 2-, and 3-year mortality of older CAP patients in the low muscle mass group (Cr/CysC*100) was also higher than the high muscle mass group (Cr/CysC*100) (1-year: 56.29% vs. 31.91%, p < 0.001; 2-year: 60.26% vs. 35.53%, p < 0.001; 3-year: 61.26% vs. 36.51%, p < 0.001). Compared to the high muscle mass group (Cr/CysC*100), the low muscle mass group (Cr/CysC*100) experienced enhanced mortality risk at the 1-, 2-, and 3-year follow ups (1-year: HR = 1.9, 95% CI: 1.46–2.48; 2-year: HR = 1.85, 95% CI: 1.44–2.39; 3-year: HR = 1.85, 95% CI: 1.44–2.37). Conclusions Low muscle mass (AST/ALT and Cr/CysC*100) were associated with enhanced 1-, 2-, and 3-year mortality risk in older patients with CAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03626-y.
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Affiliation(s)
- Sha Huang
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Yan Guo
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Lanlan Chen
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Yan Wang
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Xiaoyan Chen
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
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Sato R, Vatic M, da Fonseca GWP, von Haehling S. Sarcopenia and Frailty in Heart Failure: Is There a Biomarker Signature? Curr Heart Fail Rep 2022; 19:400-411. [PMID: 36261756 DOI: 10.1007/s11897-022-00575-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Sarcopenia and frailty are common in patients with heart failure (HF) and are strongly associated with prognosis. This review aims to examine promising biomarkers that can guide physicians in identifying sarcopenia and frailty in HF. RECENT FINDINGS Traditional biomarkers including C-reactive protein, aminotransaminase, myostatin, and urinary creatinine as well as novel biomarkers including microRNAs, suppression of tumorigenicity 2 (ST2), galectin-3, and procollagen type III N-terminal peptide may help in predicting the development of sarcopenia and frailty in HF patients. Among those biomarkers, aminotransferase, urinary creatinine, and ST2 predicted the prognosis in HF patients with sarcopenia and frailty. This review outlines the current knowledge of biomarkers that are considered promising for diagnosing sarcopenia and frailty in HF. The listed biomarkers might support the diagnosis, prognosis, and therapeutic decisions for sarcopenia and frailty in HF patients.
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Affiliation(s)
- Ryosuke Sato
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075, Gottingen, Germany
| | - Mirela Vatic
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075, Gottingen, Germany
| | | | - Stephan von Haehling
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Gottingen, Germany.
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Chen S, Wang H, Luo D, Zhang C. Postoperative Alanine Aminotransferase Levels Are Associated with Outcomes in Pediatric Patients Undergoing Total Cavopulmonary Connection. CHILDREN 2022; 9:children9091410. [PMID: 36138719 PMCID: PMC9497946 DOI: 10.3390/children9091410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
Background: This single-center, retrospective study aims to determine the association between alanine aminotransferase (ALT) and outcomes in pediatric patients undergoing total cavopulmonary connection (TCPC). Methods: In total, 256 pediatric patients undergoing TCPC were included and divided into a normal-ALT group and a high-ALT group. Clinical data were collected for comparisons between groups, and risk factors of high postoperative ALT were identified by univariate and multivariate analysis. A ROC analysis of the predictive value of postoperative ALT was conducted. Results: Compared to the normal-ALT group, the members of the high-ALT group were 1.6 years older and had significantly higher preoperative creatinine and direct bilirubin levels. The high-ALT group had increased fluid overload, higher vasoactive inotropic drug scores, and inferior central venous pressure. The short-term outcomes in the high-ALT group were markedly worse: they suffered a longer duration of mechanical ventilation (MV), had a higher ICU and hospital length of stay (LOS), and higher rates of mortality, infection, and reintubation. Prolonged ICU and hospital LOS, longer MV, and reintubation were identified as independent risk factors for high postoperative ALT. Postoperative ALT was of high value in predicting reintubation, MV, ICU LOS, and mortality. Conclusions: Elevated postoperative ALT levels are associated with poor short-term outcomes in pediatric patients undergoing TCPC.
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Ma J, Wei Z, Wang Q, Lu X, Zhou Z, Li R, Shu Q, Liu Y, Wang J, Liu N, Shi H. Association of serum creatinine with hepatic steatosis and fibrosis: a cross-sectional study. BMC Gastroenterol 2022; 22:358. [PMID: 35896972 PMCID: PMC9327226 DOI: 10.1186/s12876-022-02437-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Recent studies have shown that chronic kidney disease (CKD) prevalence is significantly higher in patients with hepatic steatosis (HS); however, it remains unclear whether HS is associated with serum creatinine (SCr). We aimed to explore the association between SCr levels and HS in a Chinese population. Methods We performed a cross-sectional study among 56,569 Chinese individuals. SCr level, other clinical and laboratory parameters, abdominal ultrasound and noninvasive fibrosis scores were extracted, and the fibrosis 4 score (FIB-4) was calculated. Results A total of 27.1% of the subjects had HS. After 1:1 propensity score matching (PSM) according to sex and age, we included 13,301 subjects with HS and 13,301 subjects without HS. SCr levels were significantly higher in the HS group than in the non-HS group [73.19 ± 15.14(μmoI/L) vs. 71.75 ± 17.49(μmoI/L), p < 0.001]. Univariate and multivariate regression analyses showed a positive association between SCr and the prevalence of HS. Stepwise regression analysis showed that the association between SCr and HS was independent of other metabolic syndrome components. The prevalence of HS increased significantly with increasing SCr levels. Metabolism-related indicators and liver enzymes were significantly higher in the HS group than in the non-HS group; furthermore, these parameters increased with increasing SCr levels. FIB-4 was significantly higher in the HS group than in the non-HS group but did not show an increasing trend with increasing SCr levels. Conclusions Our results showed an independent association between SCr level and HS risk in a Chinese population.
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Affiliation(s)
- Juan Ma
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Zhongcao Wei
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Qian Wang
- Health Management Department, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Xiaolan Lu
- Department of Gastroenterology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Huinan Town, Pudong, Shanghai, 201399, China
| | - Zhihua Zhou
- Health Management Department, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Ruohan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Qiuai Shu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Yixin Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jinhai Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
| | - Haitao Shi
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157 Xiwu Road, Xi'an, 710004, Shaanxi, China.
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Low alanine aminotransferase levels are independently associated with mortality risk in patients with atrial fibrillation. Sci Rep 2022; 12:12183. [PMID: 35842444 PMCID: PMC9288442 DOI: 10.1038/s41598-022-16435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022] Open
Abstract
Extremely low alanine aminotransferase (ALT) may reflect aging, frailty, sarcopenia, and malnutrition in several cardiovascular diseases, but the association between low ALT and patient characteristics, cardiovascular and all-cause mortality is not well investigated in the population with atrial fibrillation. We conducted a post hoc analysis of a prospective, observational multicenter study. Patients with nonvalvular AF in the SAKURA AF Registry (n = 3156) were classified into 3 tertiles according to baseline ALT: first (ALT ≤ 15 U/L, n = 1098), second (15 < ALT < 23 U/L, n = 1055), and third (ALT ≥ 23 U/L, n = 1003). The first tertile had an older age; lower body mass index (BMI); higher prevalence of heart failure; and lower hemoglobin, total cholesterol, and triglycerides (all P < 0.05). During median 39.2 months follow-up, the first tertile had significantly higher incidences of cardiovascular and all-cause mortality (log-rank P < 0.001). Lower ALT was significantly associated with the incidence of cardiovascular and all-cause mortality, even after adjusting for clinically relevant factors (P < 0.05). Low ALT may reflect aging, sarcopenia, and malnutrition and be independently associated with a high risk of all-cause mortality in patients with AF.
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Itelman E, Segev A, Ahmead L, Leibowitz E, Agbaria M, Avaky C, Negro L, Shenhav-Saltzman G, Wasserstrum Y, Segal G. Low ALT values amongst hospitalized patients are associated with increased risk of hypoglycemia and overall mortality: a retrospective, big-data analysis of 51 831 patients. QJM 2022; 114:843-847. [PMID: 32642782 DOI: 10.1093/qjmed/hcaa219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/13/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sarcopenia and frailty influence clinical patients' outcomes. Low alanine aminotransferase (ALT) serum activity is a surrogate marker for sarcopenia and frailty. In-hospital hypoglycemia is associated, also with worse clinical outcomes. AIM We evaluated the association between low ALT, risk of in-hospital hypoglycemia and subsequent mortality. DESIGN This was a retrospective cohort analysis. METHODS We included patients hospitalized in a tertiary hospital between 2007 and 2019. Patients' data were retrieved from their electronic medical records. RESULTS The cohort included 51 831 patients (average age 70.88). The rate of hypoglycemia was 10.8% (amongst diabetics 19.4% whereas in non-diabetics 8.3%). The rate of hypoglycemia was higher amongst patients with ALT < 10 IU/l in the whole cohort (14.3% vs. 10.4%, P < 0.001) as well as amongst diabetics (24.6% vs. 18.8%, P < 0.001). Both the overall and in-hospital mortality were higher in the low ALT group (57.7% vs. 39.1% P < 0.001 and 4.3% vs. 3.2%, P < 0.001). A propensity score matching, after which a regression model was performed, showed that patients with ALT levels < 10 IU/l had higher risk of overall mortality (HR = 1.21, CI 1.13-1.29, P < 0.001). CONCLUSIONS Low ALT values amongst hospitalized patients are associated with increased risk of in-hospital hypoglycemia and overall mortality.
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Affiliation(s)
- E Itelman
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - A Segev
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - L Ahmead
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - E Leibowitz
- Department of Internal Medicine "A", Yoseftal Hospital, Yotam road, POB 600. Eilat 88104, Israel
| | - M Agbaria
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - C Avaky
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - L Negro
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - G Shenhav-Saltzman
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - Y Wasserstrum
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
| | - G Segal
- From the Internal Medicine "T". Chaim Sheba Medical Center, Tel-Hashomer, 2 Sheba Road. Ramat-Gan 5262000, Israel
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Haim Levanon 55 st, Tel-Aviv 6997801, Israel
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He Y, Ding F, Yin M, Zhang H, Hou L, Cui T, Xu J, Yue J, Zheng Q. High Serum AST/ALT Ratio and Low Serum INS*PA Product Are Risk Factors and Can Diagnose Sarcopenia in Middle-Aged and Older Adults. Front Endocrinol (Lausanne) 2022; 13:843610. [PMID: 35370985 PMCID: PMC8971564 DOI: 10.3389/fendo.2022.843610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Sarcopenia is an age-related clinical condition and associated with an increased risk of adverse outcomes. However, to date, there is no global standard for the diagnosis of sarcopenia, and fewer serum biomarkers have been suggested for the diagnosis of sarcopenia. It is, thus, important that sarcopenia-related serological diagnostic markers be explored. The present study was based on the Asian Working Group on Sarcopenia 2019 (AWGS 2019) criteria to assess whether aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and fasting insulin*prealbumin (INS*PA) product are diagnostic markers associated with sarcopenia in various ethnic groups in western China. METHODS This cross-sectional study included 4,099 adults (1,471 men and 2,628 women) from the West China Health and Aging Trend (WCHAT) study. The value of serum biomarkers was based on laboratory data. The accompanying metabolic disorders and the associated parameters were evaluated. Logistic regression analysis was used to explore the association between markers and sarcopenia. Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic efficacy of the test in differentiating sarcopenia. RESULTS Binary regression analysis showed that high serum AST/ALT (OR = 2.247) and adrenal cortisol (PTC, OR = 1.511), low serum INS*PA (OR = 2.970), free triiodothyronine (FT3, OR = 1.313), 25-OH-VitD (VitD, in male participants, OR = 1.817), and diastolic blood pressure (DBP, in female subjects, OR = 1.250) were independent risk factors for sarcopenia (P < 0.05). AST/ALT and INS*PA were not affected by metabolic factors and had better diagnostic efficacy for sarcopenia. The AUC of the INS*PA was the highest (0.705, 0.706, and 0.701, respectively, P < 0.05), followed by that of the AST/ALT (0.680, 0.675, and 0.695, respectively, P < 0.05). The AUC of the AST/ALT/(INS*PA)*10,000 used to diagnose sarcopenia was 0.727. CONCLUSION Among middle-aged and older adults of multiple ethnicities in western China, we found that higher AST/ALT and lower INS*PA levels are associated with an increased prevalence of sarcopenia. Since these serum biomarkers are inexpensive and can be obtained easily from biochemical routine, regular follow-up of AST/ALT and INS*PA may be an effective strategy in sarcopenia screening and management.
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Affiliation(s)
- Yong He
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Fing Ding
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Mengting Yin
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - He Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lisha Hou
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Cui
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jinfeng Xu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Qin Zheng, ; Jirong Yue,
| | - Qin Zheng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Qin Zheng, ; Jirong Yue,
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Thaeomor A, Tangnoi C, Teangphuck P, Seanthaweesuk S, Somparn N, Naowaboot J, Roysommuti S. Perinatal Taurine Supplementation Preserves the Benefits of Dynamic Exercise Training on Cardiovascular and Metabolic Functions and Prevents Organ Damage in Adult Male Exercised Rats. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1370:185-194. [DOI: 10.1007/978-3-030-93337-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Effects of Resistance Training on Oxidative Stress Markers and Muscle Damage in Spinal Cord Injured Rats. BIOLOGY 2021; 11:biology11010032. [PMID: 35053030 PMCID: PMC8772953 DOI: 10.3390/biology11010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 01/24/2023]
Abstract
Simple Summary Spinal Cord Injury is a devastating condition that compromises the individual’s health, quality of life and functional independence. Rats submitted to Spinal Cord Injury were evaluated after four weeks of resistance training. Analyses of levels of muscle damage and oxidative stress surgery were performed. Resistance training demonstrated increase antioxidative activity while decreased oxidative damage in injured rats, in addition to having presented changes in the levels of muscle damage in that same group. The results highlight that resistance training promoted a decrease in oxidative stress and a significant response in muscle damage markers. Abstract Background: Spinal cord injury (SCI) is a condition that affects the central nervous system, is characterized by motor and sensory impairments, and impacts individuals’ lives. The objective of this study was to evaluate the effects of resistance training on oxidative stress and muscle damage in spinal cord injured rats. Methodology: Forty Wistar rats were selected and divided equally into five groups: Healthy Control (CON), Sham (SHAM) SCI Untrained group (SCI-U), SCI Trained group (SCI- T), SCI Active Trained group (SCI- AT). Animals in the trained groups were submitted to an incomplete SCI at T9. Thereafter, they performed a protocol of resistance training for four weeks. Results: Significant differences in muscle damage markers and oxidative stress in the trained groups, mainly in SCI- AT, were found. On the other hand, SCI- U group presented higher levels of oxidative stress and biomarkers of LDH and AST. Conclusion: The results highlight that resistance training promoted a decrease in oxidative stress and a significative response in muscle damage markers.
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Molecular and Metabolic Mechanism of Low-Intensity Pulsed Ultrasound Improving Muscle Atrophy in Hindlimb Unloading Rats. Int J Mol Sci 2021; 22:ijms222212112. [PMID: 34829990 PMCID: PMC8625684 DOI: 10.3390/ijms222212112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/16/2022] Open
Abstract
Low-intensity pulsed ultrasound (LIPUS) has been proved to promote the proliferation of myoblast C2C12. However, whether LIPUS can effectively prevent muscle atrophy has not been clarified, and if so, what is the possible mechanism. The aim of this study is to evaluate the effects of LIPUS on muscle atrophy in hindlimb unloading rats, and explore the mechanisms. The rats were randomly divided into four groups: normal control group (NC), hindlimb unloading group (UL), hindlimb unloading plus 30 mW/cm2 LIPUS irradiation group (UL + 30 mW/cm2), hindlimb unloading plus 80 mW/cm2 LIPUS irradiation group (UL + 80 mW/cm2). The tails of rats in hindlimb unloading group were suspended for 28 days. The rats in the LIPUS treated group were simultaneously irradiated with LIPUS on gastrocnemius muscle in both lower legs at the sound intensity of 30 mW/cm2 or 80 mW/cm2 for 20 min/d for 28 days. C2C12 cells were exposed to LIPUS at 30 or 80 mW/cm2 for 5 days. The results showed that LIPUS significantly promoted the proliferation and differentiation of myoblast C2C12, and prevented the decrease of cross-sectional area of muscle fiber and gastrocnemius mass in hindlimb unloading rats. LIPUS also significantly down regulated the expression of MSTN and its receptors ActRIIB, and up-regulated the expression of Akt and mTOR in gastrocnemius muscle of hindlimb unloading rats. In addition, three metabolic pathways (phenylalanine, tyrosine and tryptophan biosynthesis; alanine, aspartate and glutamate metabolism; glycine, serine and threonine metabolism) were selected as important metabolic pathways for hindlimb unloading effect. However, LIPUS promoted the stability of alanine, aspartate and glutamate metabolism pathway. These results suggest that the key mechanism of LIPUS in preventing muscle atrophy induced by hindlimb unloading may be related to promoting protein synthesis through MSTN/Akt/mTOR signaling pathway and stabilizing alanine, aspartate and glutamate metabolism.
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Segev A, Itelman E, Beigel R, Segal G, Chernomordik F, Matetzky S, Grupper A. Low ALT levels are associated with poor outcomes in acute coronary syndrome patients in the intensive cardiac care unit. J Cardiol 2021; 79:385-390. [PMID: 34696927 DOI: 10.1016/j.jjcc.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/25/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Frailty is an underrecognized and important entity that bears worse prognosis. Although low serum alanine aminotransferase (ALT) can serve as a novel marker of frailty, its use was never assessed in acute coronary syndrome (ACS) patients. METHODS A retrospective analysis of hospitalized ACS patients in the intensive cardiac care unit (ICCU)between 1/5/2011 and 1/12/2020 at a single tertiary medical center. RESULTS The study included 3956 patients after excluding patients with ALT >40 IU/L, cirrhosis, and missing data, followed for a medianduration of 47 months (IQR 20-77).Patients were stratified into two groups based on their first ALT measurement within the index hospitalization: low-normal ALT group (ALT ≤10 IU/L) vs. high-normal ALT group (ALT >10 IU/L). Patients with ALT≤10 IU/L were older (mean age 71 years vs. 65 years, p<0.001), presented more frequently with non-ST elevation myocardial infarction (66.4% vs. 53.2%, p< 0.001), had higher rates of comorbiditiesat baseline, and had a lower Norton score upon admission. Hospitalization length was longer in the low-normal ALT group (p< 0.001). Although the in-hospital mortality rate was similar between the groups (0.9% vs. 0.7%, p = 0.99), long-termmortality was significantly higher in the low-normal ALT group (22.7% vs. 7.9%, p< 0.001). In a multivariate regression model ALT ≤10 IU/l was associated with increased mortality (HR 2.1, 95% CI 1.46-3). CONCLUSIONS Lower serum ALT is associated with worse outcomes in ACS patients admitted to the ICCU.
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Affiliation(s)
- Amitai Segev
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Edward Itelman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
| | - Roy Beigel
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Gad Segal
- Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
| | - Fernando Chernomordik
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Shlomi Matetzky
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Avishay Grupper
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
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12
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Weber Y, Epstein D, Miller A, Segal G, Berger G. Association of Low Alanine Aminotransferase Values with Extubation Failure in Adult Critically Ill Patients: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10153282. [PMID: 34362065 PMCID: PMC8348471 DOI: 10.3390/jcm10153282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Liberation from mechanical ventilation is a cardinal landmark during hospitalization of ventilated patients. Decreased muscle mass and sarcopenia are associated with a high risk of extubation failure. A low level of alanine aminotransferase (ALT) is a known biomarker of sarcopenia. This study aimed to determine whether low levels of ALT are associated with increased risk of extubation failure among critically ill patients. Methods: This was a retrospective single-center cohort study of mechanically ventilated patients undergoing their first extubation. The study’s outcome was extubation failure within 48 h and 7 days. Multivariable logistic and Cox regression were performed to determine whether ALT was an independent predictor of these outcomes. Results: The study included 329 patients with a median age of 62.4 years (IQR 48.1–71.2); 210 (63.8%) patients were at high risk for extubation failure. 66 (20.1%) and 83 (25.2%) failed the extubation attempt after 48 h and 7 days, respectively. Low ALT values were more common among patients requiring reintubation (80.3–61.5% vs. 58.6–58.9%, p < 0.002). Multivariable logistic regression analysis identified ALT as an independent predictor of extubation failure at 48 h and 7 days. ALT ≤ 21 IU/L had an adjusted hazard ratio (HR) of 2.41 (95% CI 1.31–4.42, p < 0.001) for extubation failure at 48 h and ALT ≤ 16 IU/L had adjusted HR of 1.94 (95% CI 1.25–3.02, p < 0.001) for failure after 7 days. Conclusions: Low ALT, an established biomarker of sarcopenia and frailty, is an independent risk factor for extubation failure among hospitalized patients. This simple laboratory parameter can be used as an effective adjunct predictor, along with other weaning parameters, and thereby facilitate the identification of high-risk patients.
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Affiliation(s)
- Yoav Weber
- Department of Internal Medicine “B”, Rambam Health Care Campus, Haifa 3109601, Israel; (D.E.); (G.B.)
- Correspondence: ; Tel.: +972-054-9249749
| | - Danny Epstein
- Department of Internal Medicine “B”, Rambam Health Care Campus, Haifa 3109601, Israel; (D.E.); (G.B.)
- Critical Care Division, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Asaf Miller
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa 3109601, Israel;
| | - Gad Segal
- Department of Internal Medicine “T”, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan 6971039, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv 6997801, Israel
| | - Gidon Berger
- Department of Internal Medicine “B”, Rambam Health Care Campus, Haifa 3109601, Israel; (D.E.); (G.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
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13
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Maeda D, Kagiyama N, Jujo K, Saito K, Kamiya K, Saito H, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Wada H, Hiki M, Dotare T, Sunayama T, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Yonezawa R, Oka K, Momomura SI, Matsue Y. Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure. Sci Rep 2021; 11:11957. [PMID: 34099767 PMCID: PMC8184951 DOI: 10.1038/s41598-021-91368-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022] Open
Abstract
Frailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. We hypothesized that the AST to ALT ratio (AAR) could be a marker of frailty in patients with heart failure. Data from the FRAGILE-HF study were analyzed. A total of 1327 patients aged ≥ 65 years hospitalized with heart failure were categorized into three groups based on their AAR at discharge: low AAR (AAR < 1.16, n = 434); middle AAR (1.16 ≤ AAR < 1.70, n = 487); high AAR (AAR ≥ 1.70, n = 406). The primary endpoint was one-year mortality. The association between AAR and physical function was also assessed. High AAR was associated with lower short physical performance battery and shorter 6-min walk distance, and these associations were independent of age and sex. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. During follow-up, all-cause death occurred in 161 patients. After adjusting for confounding factors, high AAR was associated with all-cause death (low AAR vs. high AAR, hazard ratio: 1.57, 95% confidence interval, 1.02–2.42; P = 0.040). In conclusion, AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiology, Osaka Medical College, Takatsuki, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.,Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan.,Department of Cardiovascular Biology and Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Hiroshi Saito
- Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Ogasahara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Ozawa
- Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan
| | - Katsuya Izawa
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Naoki Aizawa
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Ryusuke Yonezawa
- Rehabilitation Center, Kitasato University Medical Center, Kitamoto, Japan
| | - Kazuhiro Oka
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | | | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. .,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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14
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Maeda D, Sakane K, Kanzaki Y, Okuno T, Nomura H, Hourai R, Akamatsu K, Tsuda K, Ito T, Sohmiya K, Hoshiga M. Relation of Aspartate Aminotransferase to Alanine Aminotransferase Ratio to Nutritional Status and Prognosis in Patients With Acute Heart Failure. Am J Cardiol 2021; 139:64-70. [PMID: 33115639 DOI: 10.1016/j.amjcard.2020.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
Elevated liver fibrosis markers are associated with worse prognosis in acute heart failure (AHF). The aspartate aminotransferase to alanine aminotransferase ratio (AAR) is one such fibrosis marker, and low ALT is a surrogate marker of malnutrition. Here, we evaluated the association between AAR and nutritional status and prognosis in patients with AHF. Consecutive 774 patients who were admitted due to AHF were divided into 3 groups according to AAR at discharge: first tertile, AAR<1.16 (n = 262); second tertile, 1.16≤AAR<1.70 (n = 257); and third tertile, AAR≥1.70 (n = 255). Nutritional indices and a composite of all-cause death or HF rehospitalization were compared in the 3 tertiles. Patients in the third AAR tertile were older and had lower body mass index than patients in other AAR tertiles. A higher AAR was associated with worse nutritional indices (i.e., controlling nutritional status score, geriatric nutritional risk index, and prognostic nutritional index). Clinical outcome rates significantly increased along AAR tertiles (first tertile, 28%; second tertile, 43%; third tertile, 58%, p < 0.001). Cox proportional hazards models including potential prognostic factors revealed high AAR was an independent prognostic factor of AHF. In conclusion, AAR at discharge may be associated with nutritional status and worse clinical outcomes in patients with AHF.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Kazushi Sakane
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Takahiro Okuno
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Hisafumi Nomura
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Ryoto Hourai
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Kanako Akamatsu
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Kosuke Tsuda
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan.
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15
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Segev A, Itelman E, Avaky C, Negru L, Shenhav-Saltzman G, Grupper A, Wasserstrum Y, Segal G. Low ALT Levels Associated with Poor Outcomes in 8700 Hospitalized Heart Failure Patients. J Clin Med 2020; 9:E3185. [PMID: 33008125 PMCID: PMC7600048 DOI: 10.3390/jcm9103185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia and frailty are causes for morbidity and mortality amongst heart failure (HF) patients. Low alanine transaminase (ALT) is a marker for these syndromes and, therefore, could serve as a biomarker for the prognostication of HF patients. We performed a retrospective analysis of all consecutive hospitalized HF patients in our institute in order to find out whether low ALT values would be a biomarker for poor outcomes. Our cohort included 11,102 patients, 35.6% categorized as heart failure with reduced ejection fraction. We excluded patients with ALT > 40 IU/L and cirrhosis. 8700 patients were followed for a median duration of 22 months and included in a univariate analysis. Patients with ALT < 10 IU/L were older (mean age 78.6 vs. 81.8, p < 0.001), had past stroke (24.6% vs. 19.6%, p < 0.001), dementia (7.7% vs. 4.6%, p < 0.001), and malignancy (13.4% vs. 10.2%, p = 0.003). Hospitalization length was longer in the low-ALT group (4 vs. 3 days, p < 0.001), and the rate of acute kidney injury during hospitalization was higher (19.1% vs. 15.6%; p = 0.006). The in-hospital mortality rate was higher in the low-ALT group (6.5% vs. 3.9%; p < 0.001). Long-term mortality was also higher (73.3% vs. 61.5%; p < 0.001). In a multivariate regression analysis, ALT < 10 IU/L had a 1.22 hazard ratio for mortality throughout the follow-up period (CI = 1.09-1.36; p < 0.001). Low ALT plasma level, a biomarker for sarcopenia and frailty, can assist clinicians in prognostic stratification of heart failure patients.
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Affiliation(s)
- Amitai Segev
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Edward Itelman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Chen Avaky
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Liat Negru
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gilat Shenhav-Saltzman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Avishay Grupper
- Cardiovascular Division, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel;
| | - Yishay Wasserstrum
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gad Segal
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
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16
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Yamamoto M, Kobayashi T, Kuroda S, Hamaoka M, Honmyo N, Yamaguchi M, Takei D, Ohdan H. Impact of postoperative bile leakage on long‐term outcome in patients following liver resection for hepatocellular carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:931-941. [DOI: 10.1002/jhbp.750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/03/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Masateru Yamamoto
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Michinori Hamaoka
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Naruhiko Honmyo
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Megumi Yamaguchi
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Daisuke Takei
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
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