Plasma adiponectin is an independent predictor of type 2 diabetes in Asian indians

OBJECTIVE: Adiponectin, secreted by fat cells, has regulatory functions on energy metabolism. Its low levels are predictive of future development of diabetes. Because no studies on the regulatory role of adiponectin in glucose homeostasis in Asian Indians exist, this analysis was performed to determine the prospective association of adiponectin and diabetes in subjects with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS: Baseline values of plasma adiponectin, results of anthropometry, fasting and 2-h plasma glucose levels, HbA(1c), results of lipid profile, and insulin resistance were analyzed in 91 subjects with IGT (53 men and 38 women) in a primary prevention study. Reassessment of glucose tolerance was performed during 1-year review. The predictive nature of adiponectin for development of diabetes was assessed using univariate and multiple logistic regression analyses. A control group comprising healthy, normoglycemic individuals was used for comparison. RESULTS: At follow-up, diabetes had developed in 25 of the 91 study subjects. The mean baseline adiponectin level was lower in the diabetic subjects than in the nondiabetic subjects (11.3 +/- 5.5 vs. 16.7 +/- 7.6 micro g/ml, P = 0.0017). Low adiponectin level was a strong predictor of future development of diabetes, and HbA(1c) also showed a positive predictive association. Women had higher adiponectin levels (16.4 +/- 6.1 micro g/ml) than men (13.9 +/- 7.6 micro g/ml) (P = 0.035). CONCLUSIONS: In Asian Indians, low plasma adiponectin level was predictive of future development of diabetes.     

高血压脑出血早期死亡危险的多因素分析

目的 探讨脑出血早期死亡的危险因素,为临床患者的预后判断提供依据.方法 检测110例24 h内发生基底节出血患者人院时血糖、IL-6、vWF、TNF-α的血浆浓度,结合临床资料,对24 h死亡概率进行单因素及多因素Logistic回归分析.结果 单因素Logistic回归分析表明,男性、出血量大、高血压史和入院时高IL-6、TNF-α、收缩压、血糖是基底节出血24 h死亡的危险因素(P<0.1),高vWF是保护因素(P<0.1).多因素Logistic回归分析显示,高血压史、入院时高IL-6、血糖是基底节出血24 h死亡的危险因素(P<0.1),高vWF是保护因素(P<0.1).结论 检测大脑基底节出血患者人院时血糖、IL-6、vWF的血浆浓度,结合高血压病史的有无,可能对早期死亡的预测有一定的临床指导意义.     

Fetuin-A is an independent predictor of death after ST-elevation myocardial infarction

BACKGROUND: Fetuin-A inhibits inflammation and has a protective effect against myocardial ischemia. Its deficiency has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. We investigated the association between plasma fetuin-A and clinical outcome after ST-elevation acute myocardial infarction (STEMI). METHODS: We measured fetuin-A in 284 consecutive patients with STEMI and correlated these data with the occurrence of death at 6 months (n = 25). We also measured fetuin-A in a control group and chose the 95th percentile as the cutoff to define abnormality. RESULTS: Patient mean (SD) age was 60 (14) years, and creatinine clearance was 83 (31) mL/min; 82% were men. Mean (SD) plasma fetuin-A concentrations at admission [188 (69) mg/L, P = 0.01] and at day 3 [163 (57) mg/L, P <0.0001] were lower in patients than in controls [219 (39) mg/L; 95th percentile 140 mg/L]. Fetuin-A <140 mg/L was observed in 20% of patients at admission vs 40% at day 3 (P <0.001). Fetuin-A concentrations did not correlate with peak cardiac troponin values but did correlate inversely with C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (NT-proBNP). Fetuin-A <140 mg/L at admission (OR = 3.3, P = 0.03) and at day 3 (OR = 6.3, P = 0.002) was an independent correlate of death at 6 months, irrespective of NT-proBNP, CRP, or Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score. Conversely, fetuin-A > or = 140 mg/L was associated with an excellent survival rate [negative predictive value (NPV) = 97% overall], even in high-risk populations with CADILLAC risk score > or = 6 (NPV = 90% in patients). CONCLUSIONS: Fetuin-A is an important predictor of death at 6 months in STEMI patients independent of NT-proBNP, CRP, and CADILLAC risk score.     

Diabetes is an independent risk factor for in-hospital mortality from acute spontaneous intracerebral hemorrhage

OBJECTIVE: We tested the hypothesis that diabetes is an independent determinant of outcome after intracerebral hemorrhage (ICH). RESEARCH DESIGN AND METHODS: This was a hospital-based prospective study The setting was an acute care 350-bed hospital in the city of Barcelona, Spain. Spontaneous ICH was diagnosed in 229 (11%) of 2,000 consecutive stroke patients included in a prospective stroke registry during a 10-year period. Main outcome measures were frequency of demographic variables, risk factors, clinical events, neuroimaging data, and outcome in ICH patients with and without diabetes. Variables related to vital status at discharge (alive or dead) in the univariate analysis plus age were studied in 4 logistical regression models. RESULTS: A total of 35 patients (15.3%) had diabetes. The overall in-hospital mortality rate was 54.3% in the diabetic group and 26.3% in the nondiabetic group (P < 0.001). Previous cerebral infarction, altered consciousness, sensory symptoms, cranial nerve palsy, multiple topography of the hematoma, intraventricular hemorrhage, and infectious complications were significantly more frequent in diabetic patients than in nondiabetic patients. The presence of diabetes was a significant predictive variable in the model based on demographic variables and cardiovascular risk factors (odds ratio 2.98 [95% CI 1.37-6.46]) and in the models based on these variables plus clinical variables (5.76 [2.01-16.51]), neuroimaging variables (5.59 [1.87-16.691), and outcome data (6.10 [2.04-18.291). CONCLUSIONS: Diabetes is an independent determinant of death after ICH. ICH in diabetic individuals presents some different clinical features compared with ICH in nondiabetic patients.     

Anaemia is an independent predictor of death in patients hospitalized for acute heart failure

Background  

Acute heart failure is associated with a poor prognosis. It is important to identify patients at increased risk of adverse events. The presence of anaemia could help in this regard.     

Serum arachidonic acid levels is a predictor of poor functional outcome in acute intracerebral hemorrhage

Background and aimsCorrelations between serum levels of polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA) and dihomogammalinolenic acid (DHLA) and outcomes following cardiovascular disease have been reported. This study aimed to investigate the relationship between serum levels of PUFAs (including AA) and functional outcomes among intracerebral hemorrhage (ICH) patients.MethodsFrom November 2012 to July 2020, ICH patients within 24 h from onset were enrolled. Patients were divided into a good functional outcome group (modified Rankin Scale [mRS] score at 3 months, 0–3) and a poor functional outcome group (mRS score at 3 months, 4–6). We compared baseline variables between groups.ResultsParticipants comprised 133 patients (mean age, 60 years), with 106 patients (80%) in the good functional outcome group and 27 patients (20%) in the poor functional outcome group. Higher National Institutes of Health Stroke Scale (NIHSS) score and larger hematoma on admission were more frequent in the poor functional outcome group (median NIHSS score 6 vs. 14, p < 0.001; median hematoma volume, 7.5 ml vs. 13.5 ml, p = 0.07). In terms of serum PUFA levels, only median serum AA level was significantly lower in the poor functional outcome group (212 µg/ml vs. 179 µg/ml, p = 0.002). Multivariate logistic regression analysis showed lower serum AA level was independently associated with poor functional outcome (odds ratio 0.986, 95% confidence interval 0.976–0.996, p = 0.009).ConclusionLower serum AA level was associated with poor functional outcome in ICH patients. AA may represent an important biomarker of severity among ICH patients.     

出血性脑卒中术后患者近期预后及其死亡风险方程

目的:了解出血性脑卒中(ICH)患者术后的近期预后,构建死亡风险方程,为救护措施的制定和预后评估提供指导。方法:纳入手术治疗的242例首发ICH患者,追踪术后30 d生存情况。结果:(1)本组ICH患者30 d生存率为78.0%。(2)死亡组与生存组在年龄、收缩压、血K+、NIHSS评分、GCS评分、出血部位、脑中线结构移位和发病到手术时间的暴露水平不同(P<0.05)。其中年龄(RR=1.949)、出血部位(RR=2.256)、NIHSS评分(RR=1.075)和发病到手术时间(RR=2.336,RR=2.895)是影响预后的独立因素。(3)死亡风险方程:h(t,X)/h0(t)=Exp[0.668年龄+0.841出血部位+0.072 NIHSS评分+0.849(发病到手术时间6～12 h)+1.063(发病到手术时间≥12 h)]。方程、NIHSS评分、发病到手术时间、出血部位、年龄预测死亡的ROC曲线下面积分别是0.835、0.692、0.662、0.642和0.614。结论:ICH术后具有高病死率,NIHSS评分、发病到手术时间、出血部位和年龄均可用于预后的评估,以多个指标综合评估预后的可靠性更佳。     

Anemia is an independent prognostic factor in intracerebral hemorrhage: an observational cohort study

Introduction

To date only two studies have evaluated anemia status in acute intracerebral hemorrhage (ICH) reporting that on admission anemia (OAA) was associated with larger hematoma volume, and lower hemoglobin levels during hospital stay, which related to poorer outcome. The question remains whether anemia influences outcome through related volume-effects or itself has an independent impact?

Methods

This single-center investigation included 435 consecutive patients with spontaneous ICH admitted to the Department of Neurology over five years. Functional short- and long-term outcome (3 months and 1 year) were analyzed for anemia status. Multivariate logistic and graphical regression analyses were calculated for associations of anemia and to determine independent effects on functional outcome. It was decided to perform a separate analysis for patients with ICH-volume <30cm³ (minor-volume-ICH).

Results

Overall short-term-outcome was worse in anemic patients (mRS[4-6] OAA = 93.3% vs. non-OAA = 61.2%, P < 0.01), and there was a further shift towards an increased long-term mortality (P = 0.02). The probability of unfavorable long-term-outcome (mRS[4-6]) in OAA was elevated 7-fold (OR:7.5; P < 0.01). Receiver operating characteristics curve (ROC) analysis revealed a positive but poor association of ICH-volume and anemia (AUC = 0.67) suggesting volume-undriven outcome-effects of anemia (AUC = 0.75). Multivariate regression analyses revealed that anemia, besides established parameters, has the strongest relation to unfavorable outcome (OR:3.0; P < 0.01). This is even more pronounced in minor-volume-ICH (OR:5.6; P < 0.01).

Conclusions

Anemia seems to be a previously unrecognized significant predictor of unfavorable functional outcome with independent effects beyond its association with larger hemorrhage volumes. The recognition of anemia and its treatment may possibly influence outcome after ICH and as such prospective interventional studies are warranted.     

自发性颅内出血后急性癫痫发作的相关因素分析

目的　探讨自发性颅内出血后急性癫痫发作与进展性脑水肿、中线移位和临床神经功能恶化的关系。方法　对72例脑卒中患者 (缺血性卒中 30例 ,脑出血 4 2例 )入院后进行脑电图监测 ,于出血后 2 4、4 8、72h进行头颅CT扫描 ,确定癫痫发生率、发作的时间及与出血量和中线移位的关系 ,并于出院时用Glasgow预后评分对患者进行评估。结果　共有 17例患者入院 72h内脑电图有癫痫波 ,脑出血 13例 (33% ) ,脑梗死 4例 (13% ) ,脑出血患者癫痫发生率明显高于后者 (P <0 0 5 ) ;以皮层出血发生癫痫最常见 ,其次是皮层下出血 ;发作形式以局灶性发作继发全身发作居多 ;癫痫发作患者与NIH卒中评分低和中线移位明显相关 (P <0 0 5 )。结论　脑出血常伴癫痫发作 ,与出血后脑水肿和中线移位增加有关 ,并伴有明显预后不良。     

急性脑梗死静脉溶栓后脑出血的危险因素分析

目的 :探讨与急性脑梗死静脉溶栓治疗后继发脑出血 (ICH)有关的危险因素。方法 :82例急性脑梗死患者在发病 12 h内接受了尿激酶静脉溶栓治疗 ,选取溶栓前的临床和实验室资料作为 ICH的可能危险因素 ,分析与 ICH的关系。结果 :15例患者继发 ICH(18.3% ) ,其中 6例为出血性梗死 (7.3% ) ,9例为脑实质血肿(11.0 % )。发生症状性脑出血 (SICH) 7例 ,死亡 4例。统计学分析表明继发 ICH者有较低的神经功能缺损评分 (ESS) ,ESS评分 <6 0分、溶栓前头颅 CT可见早期缺血改变 (EIC)及存在心房纤颤的患者有更高的出血率。结论 :溶栓前的神经功能缺损程度、CT早期缺血改变和心房纤颤是 ICH的危险因素。     

HMGB1 is an independent predictor of death and heart transplantation in heart failure

Background  

High-Mobility-Group Box 1 (HMGB1) has been established as an important mediator of myocardial inflammation and associated with progression of heart failure (HF). The aim of this study was to analyze the prognostic value of systemic HMGB1 levels in HF patients with ischemic and non-ischemic cardiomyopathy.     

脑出血急性期血浆脂联素白细胞介素-6的动态变化及临床意义

目的探讨脑出血患者急性期血浆脂联素、IL-6浓度的动态变化及其临床意义。方法采用ELISA法分别检测20例健康体检者及26例脑出血患者发病后24 h、72 h、7 d的血浆脂联素、IL-6浓度,对脑出血患者24 h内进行神经功能缺损程度(CSS)评分。结果脑出血患者24 h血浆脂联素浓度明显低于健康体检者(P<0.05),且逐渐下降,而IL-6浓度逐渐增高,7 d时IL-6浓度明显高于24 h(P<0.05)。合并高血压病、糖尿病并不影响脑出血患者血浆脂联素和IL-6的浓度变化(P>0.05)。24 h脑出血患者血浆IL-6与脂联素有负相关趋势,且二者24 h～7 d的变化值之间也有负相关趋势,24 h脑出血患者血浆IL-6浓度与CSS评分呈正相关,而脂联素浓度与CSS评分线性关系不明确。CSS评分与脑出血量呈正相关。结论脑出血患者急性期血浆脂联素、IL-6的浓度呈现有规律的动态变化,二者均可能参与了脑出血的病理生理过程,对脑出血患者病情及预后的判断可能有潜在的临床意义。     

关于脑出血后患者重启口服抗凝药的思考

脑出血后重启口服抗凝药(oral anticoagulant,OAC)是具有挑战性的话题.目前尚无高质量的随机对照试验能获知何时以何种方式重启OAC是安全的.最近几年一些重要研究认为,脑出血后重启OAC可降低栓塞事件的发生率和长期死亡率,且不明显增加出血风险;重启OAC在非脑叶出血患者比脑叶出血患者更安全;新型抗凝剂优...     

依达拉奉治疗急性脑出血的疗效分析

目的探讨依达拉奉对急性脑出血患者血清肿瘤坏死因子α(TNF-α)和白细胞介素-1(IL-1)水平的影响,并观察其治疗效果。方法将首次发病的急性脑出血患者90例,按病例对照研究方法随机分为对照组45例、治疗组45例,对照组是采用常规治疗,治疗组是在常规治疗基础上加用依达拉奉注射液30 mg+0.9%氯化钠注射液100 m L静脉滴注,2次/d,共14 d。比较两组患者于治疗前、后神经功能缺损程度(NIHSS)及日常生活活动量(ADL)评分,并进行疗效评定,检测患者血清TNF-α、IL-1水平的变化。结果治疗组在治疗后14 d NIHSS评分[(11.57±1.82)分]及ADL评分[(54.84±4.18)分]与对照组[(16.82±2.27)分、(45.13±3.93)分]相比,差异有统计学意义(均P0.05);治疗组临床疗效明显优于对照组(P0.05),其神经功能缺损程度明显改善,日常生活能力明显提高。治疗后,治疗组TNF-α[(13.06±2.90)ng/L]、IL-1[(4.31±2.23)ng/L]水平较对照组[(18.96±3.04)ng/L、(9.76±2.67)ng/L]比较,差异有统计学意义(均P0.05)。结论依达拉奉能减轻脑出血后炎性反应、清除自由基、改善神经功能缺损。     

The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage

BACKGROUND: Postpartum hemorrhage (PPH) is a major source of maternal morbidity. Objectives: This study's objective was to determine whether changes in hemostasis markers during the course of PPH are predictive of its severity. PATIENTS AND METHODS: We enrolled 128 women with PPH requiring uterotonic prostaglandin E2 (sulprostone) infusion. Two groups were defined (severe and non-severe PPH) according to the outcome during the first 24 hours. According to our criteria, 50 of the 128 women had severe PPH. Serial coagulation tests were performed at enrollment (H0), and 1, 2, 4 and 24 hours thereafter. RESULTS: At H0, and through H4, women with severe PPH had significantly lower fibrinogen, factor V, antithrombin activity, protein C antigen, prolonged prothrombin time, and higher D-dimer and TAT complexes than women with non-severe PPH. In multivariate analysis, from H0 to H4, fibrinogen was the only marker associated with the occurrence of severe PPH. At H0, the risk for severe PPH was 2.63-fold higher for each 1 gL(-1) decrease of fibrinogen. The negative predictive value of a fibrinogen concentration >4 gL(-1) was 79% and the positive predictive value of a concentration 相似文献   

高血压脑出血术后早期气管切开对防止肺部感染的影响

目的：研究高血压脑出血术后早期行气管切开对防止肺部感染的影响。方法：选择高血压脑出血（出血量≥40ml）、急诊开颅手术后≤24h气管切开患者30例,另急诊开颅手术后未于早期气管切开（即切开时间〉24h或未行气管切开的患者）30例,所有患者术后均用抗生素头孢三代静滴预防感染。结果：39例患者出现肺部感染,其中实验组12例,有9例感染控制,感染控制时间4～10d,平均6．5d;对照组27例,有12例感染控制,感染控制时间10～20d,平均17．2d;高血压脑出血术后早期行气管切开肺部感染率和控制感染平均时间均显著低于未早期行气管切开患者（P〈0．01）,而感染控制率显著高于未早期切开者（P〈0．05）。结论：早期气管切开能有效防止高血压脑出血术后并发的肺部感染。