Association of different biomarkers of renal function with D-dimer levels in patients with type 1 diabetes mellitus (renal biomarkers and D-dimer in diabetes)

A systematic review and meta-analysis of abnormalities in hematological and biochemical markers among Bangladeshi COVID-19 cases

Background and Aims

Abnormalities in hematological and biochemical markers are assumed to be associated with the progression of COVID-19 disease. This meta-analysis was performed to assess the consequences of abnormalities of biomarkers (D-dimers, C-reactive protein [CRP], serum ferritin, lactate dehydrogenase [LDH], random blood sugar [RBS], absolute neutrophil count [ANC], neutrophil to lymphocyte ratio (NLR), serum creatinine, and hemoglobin) in the Bangladeshi COVID-19 patients.

Methods

The data of biomarker levels in Bangladeshi COVID-19 patients were gathered from five databases: PubMed, ScienceDirect, Web of Science, Google Scholar and Bangladesh Journals Online between January 2020 to March 2022. Review Manager 5.4 was used for the meta-analysis, and Egger's test and Begg-Mazumdar's rank correlation were used to investigate publication bias.

Results

This study included 1542 patients with 567 severe and 975 nonsevere statuses. Based on the accumulated data synthesis, there is a strong correlation between disease severity and different biomarkers, including D-dimer, CRP, ferritin, LDH, RBS, NLR, and serum creatinine (MD = 1.16, p = 0.0004; MD = 22.97, p = 0.003; MD = 419.26, p < 0.00001; MD = 118.37, p = 0.004; MD = 1.96, p = 0.02; MD = 1.26, p = 0.02; and MD = 0.31, p = 0.008, respectively). A significantly decreased correlation was observed for hemoglobin levels in severe COVID-19 patients (MD = -0.73, p = 0.10).

Conclusion

The elevated biomarkers level was noticed in severe cases compared to nonsevere patients, revealing that D-dimer, CRP, ferritin, LDH, RBS, NLR, and serum creatinine are significantly correlated to COVID-19 severity. Only lower hemoglobin level was found to be associated with COVID-19 severity.

Recovery of Renal Function in Clinical Patients with Acute Kidney Injury: Impact on Mortality

Objective: To assess the different renal function recovery patterns and their impact on the mortality of non-critical patients with hospital-acquired Acute Kidney Injury. Design: A prospective cohort study was conducted from January 2017 to December 2019. Methods: The patients included were those with Acute Kidney Injury acquired during their hospitalization, identified from Kidney Disease: Improving Global Outcomes (KDIGO). Renal function recovery was calculated through the serum creatinine ratio in relation to baseline creatinine at the renal function evaluation moment. A descriptive analysis of the results was performed, and the Backward method was adopted for the multivariate analysis. Results: One-thousand five-hundred and forty-six patients were evaluated in the medical clinic and 202 (13.06%) were identified to have Acute Kidney Injury; among them, renal function recovery varied over the six months of follow-up with greater expressiveness in the second and third months (from 61.02% to 62.79%). Recovery was a protective factor against in-hospital death in the first (OR 0.24; 95% CI 0.09–0.61; p-value = 0.038) and sixth month of follow-up (OR 0.24; 95% CI 0.09–0.61; p-value = 0.003). Conclusions: The incidence of renal function recovery varied throughout the six months of follow-up and reached progressively high levels from the second to the third months. Renal recovery was a protective factor against mortality during the follow-up period.

Correlations of Serological Markers with Development of Systemic Involvement in Adult Immunoglobulin A Vasculitis: A Retrospective Study of 259 Patients in Central China

OBJECTIVE

Although relatively rare, adult immunoglobulin A vasculitis (IgAV) can lead to severe complications and longer hospitalization, and result in poor prognosis, when compared to childhood IgAV. Hence, early identification and prevention for patients prone to develop systemic involvement are essential. The purpose of this study was to explore the correlations of common serological markers with the development of systemic involvement in adult IgAV.

METHODS

A retrospective analysis was performed for adult IgAV patients, who were hospitalized in Wuhan Union Hospital between January 2016 and December 2019. A total of 259 patients were enrolled, and the pre-treatment serological markers were comprehensively assessed.

RESULTS

In the present study, 49.0% and 33.2% of patients developed renal and gastrointestinal (GI) involvement, respectively. Furthermore, the elevated levels of white blood cells count, D-Dimer (D-D), C-reactive protein (CRP) and neutrophil granulocyte ratio (NE%) >60% were significantly associated with GI involvement in the univariate analysis, while the decrease in high density lipoprotein level, and the elevated D-D and CRP levels were significantly associated with renal involvement (P<0.05). Moreover, a prediction model that combined multiple markers was established by performing a logistic regression analysis, and this presented a more favorable value of prediction than the individual serological markers.

CONCLUSION

The present study suggests that common serological markers have close correlations with systemic involvement in adult IgAV, and that the establishment of a prediction model for systemic involvement may be helpful in facilitating personalized therapeutic strategies and clinical management for IgAV patients.

Coagulation, Protease-Activated Receptors, and Diabetic Kidney Disease: Lessons from eNOS-Deficient Mice

Endothelial nitric oxide synthase (eNOS) dysfunction is known to exacerbate the progression and prognosis of diabetic kidney disease (DKD). One of the mechanisms through which this is achieved is that low eNOS levels are associated with hypercoagulability, which promotes kidney injury. In the extrinsic coagulation cascade, the tissue factor (factor III) and downstream coagulation factors, such as active factor X (FXa), exacerbate inflammation through activation of the protease-activated receptors (PARs). Recently, it has been shown that the lack of or reduced eNOS expression in diabetic mice, as a model of advanced DKD, increases renal tissue factor levels and PAR1 and 2 expression in their kidneys. Furthermore, pharmaceutical inhibition or genetic deletion of coagulation factors or PARs ameliorated inflammation in DKD in mice lacking eNOS. In this review, we summarize the relationship between eNOS, coagulation, and PARs and propose a novel therapeutic option for the management of patients with DKD.

The prognostic evaluation of CA19-9, D-dimer and TNFAIP3/A20 in patients with pancreatic ductal adenocarcinoma

ABSTRACT

This study aimed to explore the significance and prognostic value of serum tumor-associated carbohydrate antigen 19-9 (CA19-9), D-dimer, and tumor necrosis factor alpha-induced protein 3 (TNFAIP3/A20) in patients with pancreatic ductal adenocarcinoma (PDAC).Our study included 148 patients treated for PDAC at Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January 2012 to December 2016. Cutoff prognostic values were predicted using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to assess the survival rates of patients. Univariate and multivariate COX regression analyses were used to evaluate the prognostic factors.The recommended cutoff values of neutrophil-lymphocyte rate (NLR), platelet-lymphocyte rate (PLR), CA19-9, and D-dimer were 2.04 (sensitivity, 0.59; specificity, 0.9; area under the ROC curve [AUC], 0.749; P < .001), 52.94 (sensitivity, 0.73; specificity, 0.95; AUC, 0.829; P < .001), 176.66 U/mL (sensitivity, 0.7; specificity, 0.9; AUC, 0.794; P < .001), and 1.18 mg/L (sensitivity, 0.82; specificity, 0.9; AUC, 0.845; P < .001), respectively. Positive TNFAIP3/A20 expression was considered as an inclusion criterion. Serum CA19-9 expression was related with lymph node metastasis (P = .010), tumor-lymph node-metastasis (TNM) stage (P < .001), and survival rate (P < .001). D-dimer was correlated with tumor differentiation grade (P = .014), tumor size (P = .045), TNM stage (P < .001), and survival rate (P < .001). TNFAIP3/A20 was correlated with tumor differentiation grade (P < .001), body mass index (BMI) (P < .001), TNM stage (P = .014), and survival rate (P < .001). Kaplan-Meier curves showed that PDAC patients had significant differences in CA19-9, D-dimer, and TNFAIP3/A20 expressions (P < .05). CA19-9, D-dimer, TNM stage, tumor differentiation grade, and TNFAIP3/A20 were independent prognostic markers for PDAC in univariate and multivariate COX analyses.CA19-9, D-dimer, and TNFAIP3/A20 were found to be independent prognostic markers for PDAC patients.

Role of hypoxia-inducible factor 1α as a potential biomarker for renal diseases-A systematic review

Renal cells need oxygen for homeostasis; it is known for adjusting cellular functioning and the energy obtainment have a broad relationship with cellular respiration, through the O₂ bioavailability. O₂ homeostasis regulation in the kidney is mediated by hypoxia-inducible factors (HIFs). HIF is divided into three α isoforms, represented by HIF-1α, HIF-2α, and HIF-3α in addition to three paralogs of HIF-1β; these are involved in some metabolic processes, as well as in the pathogenesis of several diseases. Renal biopsy analyses of patients and experimental animal models aim to understand the relationship between HIF and protection against developing renal diseases or the induction of their onset, being thus this molecule can be considered a potential biomarker of renal disease. We carried out a systematic review to which we included studies on HIF-1α and renal disease in the last 5 years (2013-2018) in researches with humans and/or animal model through searches in three databases: LILACS, PubMed, and SciELO by two researchers. We obtained 22 articles that discussed the relationship with HIF as inductor or protector against renal disease and no relation between HIF and renal. We observed controversies remain regarding the relation between of HIF with renal diseases; this may be related to the different intracellular pathways mediated by HIF-1α, thereby determining differentiated cellular responses.

Indicators of Male Gout Patients' Comorbidities with the Theory on Traditional Chinese Medicine

Gout, typically manifesting as acute burning pain and swelling in a joint, has a high frequency of comorbidities. Based on Traditional Chinese Medicine syndrome (TCMS) theory, obstruction of dampness and heat syndrome (ODHS) and intermingled phlegm-stasis blood syndrome (IPSBS) were the two main TCMS subtypes in Chinese suffering from acute gout. In this study, we did a retrospective study enrolling 4,417 ODHS male gout cases and 1,413 IPSBS male gout cases, to investigate the comorbidities distribution difference between the two subtype groups and seek the potential indicators of male gout with some comorbidities. Interestingly, we found male ODHS group with higher prevalence of possible kidney damage (ODHS: 4.34%; IPSBS: 0.78%), lower prevalence of cardiac-cerebral vascular diseases (ODHS: 0.52%, IPSBS: 0.85%) and diabetes (ODHS: 1.06%; IPSBS: 1.63%) than male IPSBS group. And cystatin C is the only index reflecting that renal function showed significant difference between the two groups and the average levels were out of the normal range (1.09 ± 0.28 versus 1.17 ± 0.31, p=0.001). Further, we also observed significance difference on abnormality rates of cystatin C between the two groups. (χ2=5.543, p= 0.019). Besides, the comparison between the two subtypes also showed significant difference on hematocrit (43.12 ± 3.60 versus 42.26 ± 4.17%, p=0.007), mean corpuscular volume (89.52 ± 6.07 versus 86.81 ± 7.11fL, p=0.001), and mean corpuscular hemoglobin concentration (338.00 ± 11.67 versus 334.86 ± 13.58g/L, p=0.004). In general, we put forward that male gout patients with ODHS should be more vigilant of damage of renal function, and those with IPSBS should pay more attention to prevent cardiac-cerebral vascular diseases and diabetes. Increased Cys C level might be correlated with risk of comorbidities, especially diabetes . Thus, it is of significance to diagnose the TCMS in acute gout accurately and monitored related indices to prevent comorbidities.