Biomarcadores cardíacos: Presente y futuro

En la actualidad, las enfermedades cardiovasculares se consideran la pandemia más significativa del siglo XXI. Dentro de ellas, la enfermedad coronaria es la más prevalente y la que más morbi-mortalidad genera; en el caso particular de Colombia, es la principal causa de muerte en individuos mayores de 45 años. La característica silenciosa de esta enfermedad ha impulsado la investigación de moléculas que permitan su diagnóstico precoz y sirvan como predictores pronóstico tanto en la fase crónica como en la aguda.Fruto de estas investigaciones, en los últimos treinta años se ha producido un avance importante en el desarrollo de biomarcadores cardiacos. Entre ellos están los recién desarrollados ensayos de troponinas ultrasensibles para diagnóstico temprano, la medición de la albúmina modificada por isquemia que cuenta con alto valor predictivo negativo para la detección de isquemia miocárdica, el ligando de CD40 soluble para la clasificación e individualización del tratamiento, la utilidad de la proteína C reactiva como marcador de riesgo de enfermedad coronaria y las diversas técnicas de alto rendimiento como la proteómica, que permite la detección de múltiples biomarcadores potenciales. A pesar de ello, aún no se dispone de evidencia suficiente para sustituir los marcadores que recomiendan las asociaciones científicas por los nuevos marcadores que se han ido desarrollando, y continúa el debate sobre qué combinación utilizar para alcanzar mayor rendimiento diagnóstico, pronostico y terapéutico. A continuación se revisan los avances actuales en biomarcadores cardiacos y su potencial integración a la práctica clínica habitual.Cardiovascular diseases are currently considered the most significant pandemic of the XXI century. Among them, coronary disease is the most prevalent and the one that generates more morbidity and mortality. In Colombia, is the main cause of death in individuals over 45 years. The silent characteristics of this disease has promoted research of molecules that allow early diagnosis and serve as predictors of prognosis both in chronic and acute phases.As result of this research, there has been significant progress in the development of cardiac biomarkers in the last thirty years. Among them are the newly developed ultrasensitive troponin assays for an early diagnosis, measurement of ischemia modified albumin, which has high negative predictive value for the detection of myocardial ischemia, soluble CD40 ligand for classification and individualization of treatment, the usefulness of CRP as a risk marker for coronary heart disease and various high-throughput techniques such as proteomics, which allow the detection of multiple potential biomarkers. Despite this, there is still insufficient evidence for replacing the markers recommended by the scientific associations by new developed markers, and the debate about what combination to use in order to achieve higher performance diagnosis, prognosis and therapy, continues Here we review current advances in cardiac biomarkers and their potential integration into daily clinical practice

Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals

ABSTARCT: Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch