1
|
Spilack ADM, Goulart AC, Janovsky CCPS, de Almeida-Pittito B, Lotufo PA, Sommer Bittencourt M, Generoso G, de Souza Santos I, Bensenor IM. The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 68:e220375. [PMID: 37988662 PMCID: PMC10916802 DOI: 10.20945/2359-4292-2022-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/23/2023] [Indexed: 11/23/2023]
Abstract
Objective We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.
Collapse
Affiliation(s)
- Aída de Melo Spilack
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carolina C P S Janovsky
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bianca de Almeida-Pittito
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo A Lotufo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Giuliano Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Itamar de Souza Santos
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Isabela M Bensenor
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
2
|
Demir AN, Kara Z, Durcan E, Sulu C, Atar OA, Zulfaliyeva G, Karaca C, Ozkaya HM, Seyahi N, Konukoglu D, Gonen MS. Do not forget the kidney in graves' disease. Int Urol Nephrol 2023; 55:2667-2673. [PMID: 37093438 DOI: 10.1007/s11255-023-03600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/15/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To investigate the prevalence of microalbuminuria and factors associated with microalbuminuria in Graves' Disease (GD). METHODS This cross-sectional and single-center study included 99 patients with GD and 47 healthy controls (HC). Exclusion criteria such as active infection, uncontrolled diabetes, and chronic kidney disease were applied to the participants. The participants' clinical findings, comorbidities, drug use, laboratory tests, and thyroid antibody levels were recorded. Spot urine samples were collected and stored at - 80 ℃ to analyze the presence of microalbuminuria. RESULTS The prevalence of microalbuminuria in patients with GD was 12.1%. The median microalbumin/creatinine ratio in spot urine (UACR) in patients with GD (9.49 mg/g [5.09-18.10]) was higher than in the HC group (7.99 mg/g [3.48-12.88], p = 0.033). UACR was correlated with thyroid-stimulating hormone receptor antibody (TRAb), thyroid-stimulating hormone (TSH), and free triiodothyronine (FT3) levels (p = 0.020, p = 0.006, p = 0.009 respectively). In the regression analysis, only the relationship between TRAb level and UACR remained (p = 0.040). CONCLUSION This study demonstrates an increased prevalence of microalbuminuria in patients with GD. There was a significant correlation between microalbuminuria and TRAb level in patients with GD. This relationship suggests that one of the underlying mechanisms of microalbuminuria seen in patients with GD may be autoimmunity.
Collapse
Affiliation(s)
- Ahmet Numan Demir
- Department of Endocrinology, Metabolism, and Diabetes, Medical Faculty, Istanbul University-Cerrahpasa, Campus Kocamustafapasa Street No:53 Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Zehra Kara
- Department of Endocrinology, Metabolism, and Diabetes, Medical Faculty, Istanbul University-Cerrahpasa, Campus Kocamustafapasa Street No:53 Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Emre Durcan
- Department of Endocrinology, Metabolism, and Diabetes, Medical Faculty, Istanbul University-Cerrahpasa, Campus Kocamustafapasa Street No:53 Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Cem Sulu
- Department of Endocrinology, Metabolism, and Diabetes, Medical Faculty, Istanbul University-Cerrahpasa, Campus Kocamustafapasa Street No:53 Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Oznur Aydin Atar
- Department of Internal Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Guldana Zulfaliyeva
- Department of Internal Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Cebrail Karaca
- Department of Nephrology, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Department of Endocrinology, Metabolism, and Diabetes, Medical Faculty, Istanbul University-Cerrahpasa, Campus Kocamustafapasa Street No:53 Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Dildar Konukoglu
- Department of Medical Biochemistry, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Mustafa Sait Gonen
- Department of Endocrinology, Metabolism, and Diabetes, Medical Faculty, Istanbul University-Cerrahpasa, Campus Kocamustafapasa Street No:53 Cerrahpasa, Fatih, 34098, Istanbul, Turkey.
| |
Collapse
|
3
|
Allam MA, Nassar YA, Shabana HS, Mostafa S, Khalil F, Zidan H, Abo-Ghebsha M, Abdelghaffar A, Essmat A, Elmahdi E. Prevalence and Clinical Significance of Subclinical Hypothyroidism in Diabetic Peripheral Neuropathy. Int J Gen Med 2021; 14:7755-7761. [PMID: 34785933 PMCID: PMC8579825 DOI: 10.2147/ijgm.s337779] [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: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background and Aim Diabetic peripheral neuropathy (DPN) is one of the most common and disabling complications of DM. Many studies documented the prevalence of clinical and subclinical hypothyroidism (SCH) in diabetic patients but not in the particular group of patients with DPN. The present study aimed to determine the prevalence of SCH in DPN patients and to evaluate its association with severity of DPN. Patients and Methods The present cross-sectional study was conducted on 300 consecutive patients with DPN. The clinical manifestations of DPN were documented according to the validated Arabic version of the Michigan Neuropathy Screening Instrument. Severity of DPN was categorized into mild (6–8 points), moderate (9–11 points) or severe (12+ points) according to the Toronto Clinical Scoring System. All patients were submitted to careful history-taking and full clinical and neurological examination. Patients were diagnosed with SCH if they had TSH level above the upper limit of the normal reference range in association with normal free thyroxine (FT4) level. Results SCH was prevalent in 53 patients (17.7%, 95% CI: 13.5%–22.5%). Patients with SCH had significantly higher frequency of severe DPN (52.8% versus 28.3%, p=0.003). It was also shown that patients with SCH had significantly higher HbA1c (8.4 ± 1.0 versus 7.3 ± 1.2%, p<0.001) and HOMA-IR (3.7 ± 0.8 versus 2.7 ± 0.9, p<0.001) when compared with patients without SCH. Logistic regression analysis identified patients’ age [OR (95% CI): 1.06 (1.03–1.08), p<0.001], HbA1c [OR (95% CI): 2.2 (1.7–2.9), p<0.001] and SCH [OR (95% CI): 7.7 (3.6–15.5), p<0.001] as independent predictors of DPN severity. Conclusion The present study showed that SCH is highly prevalent in DPN patients and is independently related to its severity.
Collapse
Affiliation(s)
- Mahmoud A Allam
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Youssef A Nassar
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hosameldeen S Shabana
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sadek Mostafa
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Farag Khalil
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hendawy Zidan
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Abo-Ghebsha
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Amir Abdelghaffar
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Essmat
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Essam Elmahdi
- Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
4
|
Zhu W, Dong X, Pan Q, Hu Y, Wang G. The association between albuminuria and thyroid antibodies in newly diagnosed type 2 diabetes mellitus patients with Hashimoto's thyroiditis and euthyroidism. BMC Endocr Disord 2020; 20:172. [PMID: 33228616 PMCID: PMC7684712 DOI: 10.1186/s12902-020-00650-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microalbuminuria is a prognostic marker of diabetes kidney disease. It is generally diagnosed as the ratio of urinary albumin to creatinine (UACR) of 30-300 mg/g. Hashimoto's thyroiditis is a common disease in the endocrinology and the thyroid antibodies may associated with kidney disease. We investigated the UACR in the newly diagnosed T2DM with Hashimoto's thyroiditis and tried to detect the relationship between the UACR and thyroid antibodies. METHODS One hundred twenty newly diagnosed T2DM patients with Hashimoto's thyroiditis and euthyroidism and 50 sex and age-matched T2DM with non-Hashimoto's and other thyroid disease were recruited. T2DM patients were divided into 2 groups by the titer of TPOAb: (1). TPOAb (+) group: T2DM with positive TPOAb (n = 105); (2). TPOAb (-) group: T2DM with negative TPOAb (n = 65). RESULTS T2DM with positive TPOAb group had higher UACR than T2DM with negative TPOAb group (21.55 ± 7.28 vs 15.13 ± 5.69 mg/g, P < 0.01). UACR were positively related to BMI (r = 0.255, P < 0.05), FPG (r = 0.285, P < 0.05), HbA1c (r = 0.260, P < 0.05) and TPOAb (r = 0.349, P < 0.05). HbA1c (β = 0.793, P < 0.05), BMI (β = 0.342, P < 0.05) and lnTPOAb (β = 1.207, P < 0.05) were independently associated with UACR. CONCLUSIONS In the newly diagnosed T2DM patients, Hashimoto's thyroiditis with TPOAb positive had higher UACR levels. TPOAb titer, BMI and HbA1c were independent associated with UACR in these patients.
Collapse
Affiliation(s)
- Wei Zhu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
- Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, 100076, People's Republic of China
| | - Xuejie Dong
- Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, 100076, People's Republic of China
| | - Qingrong Pan
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Yanjin Hu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
| |
Collapse
|
5
|
Bai X, Luo Q, Tan K, Guo L. Diagnostic value of VDBP and miR-155-5p in diabetic nephropathy and the correlation with urinary microalbumin. Exp Ther Med 2020; 20:86. [PMID: 32968443 PMCID: PMC7500046 DOI: 10.3892/etm.2020.9214] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 06/05/2020] [Indexed: 12/11/2022] Open
Abstract
This study explored the diagnostic and therapeutic significance of vitamin D binding protein (VDBP) and miR-155-5p for diabetic nephropathy and the correlation with urinary microalbumin. A total of 145 patients with type 2 diabetes who attended the Hwamei hospital were selected as research objects and assigned to diabetic nephropathy group (DN group) and diabetes group according to whether they suffered from diabetic nephropathy (DN). The expression levels of urine VDBP and serum miR-155-5p in the two groups were detected, and the correlation between urinary microalbumin (mAlb), serum cystatin C (Cys C) and 24-h urinary protein was analyzed. The predictive value of single and joint detection of urinary VDBP and serum miR-155-5p for DN onset and poor prognosis was analyzed. In DN patients, urine VDBP and serum miR-155-5p were highly expressed, and urine VDBP, serum miR-155-5p and mAlb, Cys C and 24-h urine protein were positively correlated (P<0.05). Moreover, the joint detection of urine VDBP and serum miR-155-5p was more valuable in diagnosis and poor prognosis prediction of DN patients than its single detection. Urine VDBP and serum miR-155-5p have good diagnostic value for DN, but their joint diagnostic value is higher, and their expression levels are all related to mAlb of DN patients, which may be used as new biological indicators for diagnosis and disease assessment.
Collapse
Affiliation(s)
- Xu Bai
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315000, P.R. China
| | - Qun Luo
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315000, P.R. China
| | - Kuibi Tan
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315000, P.R. China
| | - Liming Guo
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315000, P.R. China
| |
Collapse
|
6
|
Liu H, Zhang J, Yu J, Li D, Jia Y, Cheng Y, Zhang Q, Liao X, Liu Y, Wu J, Zeng Z, Cao Y, Zeng R, Wan Z, Gao Y. Prognostic value of serum albumin-to-creatinine ratio in patients with acute myocardial infarction: Results from the retrospective evaluation of acute chest pain study. Medicine (Baltimore) 2020; 99:e22049. [PMID: 32871964 PMCID: PMC7458165 DOI: 10.1097/md.0000000000022049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The long-term association between serum albumin-to-creatinine ratio (sACR) and poor patient outcomes in acute myocardial infarction (AMI) remains unclear. This study aimed to determine whether sACR was a predictor of poor long-term survival in patients with AMI.This was a study of patients with AMI in the emergency department (ED) from the retrospective multicenter study for early evaluation of acute chest pain (REACP) study. The patients were categorized into tertiles (T1, T2, and T3) based on the admission sACR (0.445 and 0.584 g/μmol). Baseline sACR at admission to the ED was predictive of adverse outcomes. The primary outcome was all-cause mortality within the follow-up period. Cox proportional hazards models were performed to investigate the association between sACR and all-cause mortality in patients with AMI.A total of 2250 patients with AMI were enrolled, of whom 229 (10.2%) died within the median follow-up period of 10.7 (7.2-14.6) months. Patients with a lower sACR had higher all-cause mortality and adverse outcomes rates than patients with a higher sACR. Kaplan-Meier survival analysis showed that patients with a higher sACR had a higher cumulative survival rate (P < .001). Cox regression analysis showed that a decreased sACR was an independent predictor of all-cause mortality [T2 vs T1: hazard ratio (HR); 0.550, 95% confidence interval (95% CI), 0.348-0.867; P = .010 and T3 vs T1: HR, 0.305; 95% CI, 0.165-0.561; P < .001] and cardiac mortality (T2 vs T1: HR, 0.536; 95% CI, 0.332-0.866; P = .011 and T3 vs T1: HR, 0.309; 95% CI, 0.164-0.582, P < .001).The sACR at admission to ED was independently associated with adverse outcomes, indicating that baseline sACR was a useful biomarker to identify high-risk patients with AMI at an early phase in ED.
Collapse
Affiliation(s)
- Hong Liu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Jianna Zhang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Jing Yu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Jia
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yisong Cheng
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Qin Zhang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- Department of General Practice, International Hospital of Sichuan Province, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanmei Liu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Wu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Cao
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China School of Nursing, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| |
Collapse
|