Association of copeptin levels with patient prognosis and survival in sepsis syndromes: a meta-analysis

BACKGROUND

Sepsis syndromes are a major burden in the ICU with very high mortality. Vasopressin and copeptin are released in response to hypovolemia and have shown potential significance in diagnosing sepsis.

OBJECTIVE

To investigate the levels of copeptin in patients with sepsis syndromes and evaluate its relation with patient prognosis and mortality.

METHODS

Four databases were searched for literature published from inception to the 8th of November 2022. Original research articles where copeptin was measured in sepsis patients and compared with controls were included. Data extraction and synthesis: study characteristics, levels of copeptin in the participants, and copeptin assay description were extracted. Levels of copeptin in patients were pooled and compared with controls in terms of the standard mean difference (SMD) generated using a random-effects model.

RESULTS

Fifteen studies met the selection criteria. Copeptin levels were significantly higher in patients with sepsis, severe sepsis, and septic shock as compared to controls [(SMD: 1.49, 95% CI: 0.81-2.16, P<0.0001), (SMD: 1.94, 95% CI: 0.34-3.54, P=0.02), and (SMD: 2.17, 95% CI: 0.68-3.66, P=0.004), respectively]. The highest copeptin levels were noted in septic shock patients. The admission copeptin levels were significantly lower in survivors as compared to nonsurvivors (SMD: -1.73; 95% CI: -2.41 to -1.06, P<0.001).

CONCLUSION AND RELEVANCE

Copeptin was significantly elevated in sepsis, severe sepsis, and septic shock. Survivors had a significantly lower copeptin during admission. Copeptin offered an excellent predictability to predict 1-month mortality. Measuring the copeptin in sepsis patients can aid treating physicians to foresee patients' prognosis.

An interesting case of unintentional vitamin D toxicity in an infant due to erroneous supplement concentration: a case report

Despite the rare occurrence of vitamin D toxicity in infants, increased use of vitamin D formulations as well as incorrect supplement concentration by manufacturing pharmaceutical companies, has contributed to an increased incidence of vitamin D toxicity. Over-the-counter vitamin D preparation constitutes variable concentrations that can render life-threatening consequences in children.

Case presentation

Here, we present a case of a 2.5-month-old infant presenting with failure to thrive. The clinical presentations were nasal blockage, noisy breathing, poor feeding, lethargy, dehydration, and fever for 3 days with decreased appetite. Her urine culture report showed a urinary tract infection. The biochemical evaluation demonstrated raised total serum calcium (6.0 mmol/l) and serum 25-hydroxy vitamin D (>160 ng/ml) with suppressed parathyroid hormone concentration (3.7 pg/ml), which was the major concern to the clinicians. On ultrasonographical examination, nephrocalcinosis was observed. Further evaluation unveiled that the vitamin D supplement administered to the infant constituted a deucedly high dose of 42 000 IU instead of the recommended dose of 0.5 ml of 800 IU.

Clinical discussion

The patient developed vitamin D toxicity after consuming a mega dose of vitamin D supplements due to a manufacturer error.

Conclusions

Hypervitaminosis D has severe life-threatening consequences like failure to thrive in otherwise healthy-born infants. Regular monitoring of vitamin D supplements administered in infants by medicinal practitioners and strict supervision of all stages of the production process by pharmaceutical companies is crucial to prevent complications from supplement overdose.

Lifestyle Practices and Obesity in Nepalese Youth: A Cross-sectional Study

Introduction

Understanding the lifestyle factors associated with obesity is critical to create a successful intervention that would prevent or reduce the obesity beforehand. However, these factors have not been assessed among Nepalese youths thus far. This study aims to determine the prevalence of obesity and to explore the potential lifestyle risk factors in young university students of Nepal.

Methods

We included in the study 384 young students aged between 17 and 24 years, pursuing medicine at Tribhuvan University, Institute of Medicine, in this cross-sectional study. A self-administered questionnaire to collect information about age, sex, smoking, alcohol consumption, meat consumption, fast-food consumption, and sedentary lifestyle was employed. Anthropometric measurements were taken to calculate body mass index (BMI) and waist-to-hip ratio (WHR).

Results

This study revealed that the current, episodic heavy alcohol consumers, current cigarette smokers, and individuals with a sedentary lifestyle had a statistically significant higher BMI and WHR as compared to age and gender-matched healthy subjects. Meat consumers as well had a statistically significant higher BMI. However, there has been no statistically significant difference in BMI and WHR in those who consume fast food from those who don’t.

Conclusion

Our study shows a high prevalence of obesity among young university students of Nepal, making it necessary to develop effective preventive measures to reduce their exposure to the risk factors associated with obesity. Early interventions to encourage lifestyle changes can be a worthwhile and effective strategy to prevent and/or reduce the risks for the development of cardiovascular diseases (CVD) and other comorbidities.

Dyslipidemia and Associated Cardiovascular Risk Factors among Young Nepalese University Students

Introduction

Cardiovascular diseases are one of the main causes of morbidity and mortality worldwide, atherosclerosis being the principal underlying cause of cardiovascular diseases. Early detection of dyslipidemia and long-term prevention of atherosclerosis by controlling risk factors should begin in young age. The purpose of this study was to assess dyslipidemia and associated cardiovascular risk factors among university students of Nepal.

Methods

A sample of 280 students aged 17–24 years, were selected randomly from Institute of Medicine, Tribhuvan University. An interview-based questionnaire was designed and information was collected on the basis of age, gender, smoking and alcohol consumption. Body mass index and waist-to-hip ratio of all participants were calculated. Fasting blood samples were collected from all participants and assayed for fasting serum total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein.

Results

Overall, dyslipidemia was seen as hypercholesterolemia in 31 (11.1%), elevated low-density lipoprotein in 34 (12.1%), low high-density lipoprotein in 95 (33.9%) and hypertriglyceridemia in 39 (13.9%). Current smoking and binge drinking were significantly associated with hypercholesterolemia. Gender, binge drinking, and current smoking were found to be significantly associated with elevated low-density lipoprotein. All factors were significantly associated with hypertriglyceridemia. There was no statistically significant association between risk factors and the low high-density lipoprotein. Body mass index and waist-to-hip ratio were significantly higher in subjects with hypercholesterolemia, hypertriglyceridemia, and elevated low-density lipoprotein level.

Conclusions

The prevalence of dyslipidemia was high in young Nepalese university students. Screening the levels of lipids in youth, especially those at risk, and accurate follow-up of those with dyslipidemia can be done to reduce morbidity and mortality.

Type 2 diabetes mellitus with early phase acute inflammatory protein on serum protein electrophoresis

Background: The onset of Type 2 diabetes has been associated with low grade systemic inflammation. The inflammatory status has been studied by measuring acute phase reactant proteins like hsCRP, α1- antitrypsin, α1-acid glycoprotein, ceruloplasmin, fibrinogen. Most of these acute phase reactants form α1 and α2 bands on electropherogram of serum proteins. The aim of this study was to evaluate inflammatory status in controlled and uncontrolled type 2 diabetes using cellulose acetate electrophoresis and to find the impact of glycemic status as indicated by HbA1c on inflammation process. Materials and Methods: Serum protein electrophoresis was done on serum samples of 60 cases of Diabetes [controlled and uncontrolled] using cellulose acetate paper technique. The electropherogram obtained was stained with Ponseu S and then quantitated using densitometer. Glycemic status was studied by HbA1c analysis. The density of α1and α2 bands in electropherogram were correlated with HbA1c level. Result: A significant increase in the percentage of α1 and α2 band proteins (0.765 and 0.716, p<0.001) were found with the increasing level of HbA1c. With cutoff of HbA1c 7% (American Diabetic Association recommended), the α1 and α2 serum proteins concentration are significantly higher (p<0.001) in uncontrolled diabetes mellitus compared to controlled diabetes mellitus Conclusion: Cellulose acetate electrophoresis of serum proteins show early phase acute inflammatory status in uncontrolled type 2 diabetes mellitus. The process of systemic inflammation worsens with uncontrolled glycemia as indicated by HbA1c. Inflammatory status should be studied adjunct to glycemic status. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6024 JPN 2012; 2(3): 211-214