Intra-abdominal pressure and its relationship with markers of congestion in patients admitted for acute decompensated heart failure

Systemic congestion is one of the mechanisms involved in acute decompensated heart failure (ADHF). Increased intra-abdominal pressure (IAP), elicited by abdominal congestion, has been related to acute kidney injury and prognosis. Nonetheless, the link between diuretic response, surrogate markers of congestion and renal function remains poorly understood. We measured IAP in 43 patients from a non-interventional, exploratory, prospective, single center study carried out in patients admitted for ADHF. IAP was measured with a calibrated electronic manometer through a catheter inserted in the bladder. Normal IAP was defined as 12 mmHg at 72 h. In patients with ADHF, higher IAP at admission is associated with poorer baseline renal function and impaired diuretic response. The persistence of IAP at 72 h above 12 mmHg associates to longer length of hospital stay and higher 1-year all-cause mortality

ANGPTL3 gene variants in subjects with familial combined hyperlipidemia

Angiopoietin-like 3 (ANGPTL3) plays an important role in lipid metabolism in humans. Loss-of-function variants in ANGPTL3 cause a monogenic disease named familial combined hypolipidemia. However, the potential contribution of ANGPTL3 gene in subjects with familial combined hyperlipidemia (FCHL) has not been studied. For that reason, the aim of this work was to investigate the potential contribution of ANGPTL3 in the aetiology of FCHL by identifying gain-of-function (GOF) genetic variants in the ANGPTL3 gene in FCHL subjects. ANGPTL3 gene was sequenced in 162 unrelated subjects with severe FCHL and 165 normolipemic controls. Pathogenicity of genetic variants was predicted with PredictSNP2 and FruitFly. Frequency of identified variants in FCHL was compared with that of normolipemic controls and that described in the 1000 Genomes Project. No GOF mutations in ANGPTL3 were present in subjects with FCHL. Four variants were identified in FCHL subjects, showing a different frequency from that observed in normolipemic controls: c.607-109T>C, c.607-47_607-46delGT, c.835+41C>A and c.*52_*60del. This last variant, c.*52_*60del, is a microRNA associated sequence in the 3'UTR of ANGPTL3, and it was present 2.7 times more frequently in normolipemic controls than in FCHL subjects. Our research shows that no GOF mutations in ANGPTL3 were found in a large group of unrelated subjects with FCHL

Implicación de la congestión venosa sistémica en la insuficiencia cardíaca

Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment

Multiple approaches at admission based on lung ultrasound and biomarkers improves risk identification in COVID-19 patients

Background: Risk stratification of COVID-19 patients is fundamental to improving prognosis and selecting the right treatment. We hypothesized that a combination of lung ultrasound (LUZ-score), biomarkers (sST2), and clinical models (PANDEMYC score) could be useful to improve risk stratification. Methods: This was a prospective cohort study designed to analyze the prognostic value of lung ultrasound, sST2, and PANDEMYC score in COVID-19 patients. The primary endpoint was in-hospital death and/or admission to the intensive care unit. The total length of hospital stay, increase of oxygen flow, or escalated medical treatment during the first 72 h were secondary endpoints. Results: a total of 144 patients were included; the mean age was 57.5 ± 12.78 years. The median PANDEMYC score was 243 (52), the median LUZ-score was 21 (10), and the median sST2 was 53.1 ng/mL (30.9). Soluble ST2 showed the best predictive capacity for the primary endpoint (AUC = 0.764 (0.658–0.871); p = 0.001), towards the PANDEMYC score (AUC = 0.762 (0.655–0.870); p = 0.001) and LUZ-score (AUC = 0.749 (0.596–0.901); p = 0.002). Taken together, these three tools significantly improved the risk capacity (AUC = 0.840 (0.727–0.953); p = 0.001). Conclusions: The PANDEMYC score, lung ultrasound, and sST2 concentrations upon admission for COVID-19 are independent predictors of intra-hospital death and/or the need for admission to the ICU for mechanical ventilation. The combination of these predictive tools improves the predictive power compared to each one separately. The use of decision trees, based on multivariate models, could be useful in clinical practice. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/)

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

Introduction: Hospitalization for Acute Decompensation of Heart Failure (ADHF) is a frequent event associated with long-term adverse effects. Prognosis is even worse if Acute Kidney Injury (AKI) occurs during hospitalization. Objectives: To determine whether kidney damage biomarkers NGAL, KIM-1 and IL-18 might predict AKI and have prognostic value of in ADHF. Patients and methods: Serum NGAL on admission and urine NGAL, KIM-1 and IL-18 on discharge were determined in 187 ADHF patients enrolled in a prospective, observational, unblinded study. AKI was diagnosed using the KDIGO criteria. Patients were followed-up for 12 months to record all-cause mortality. Results: 22% patients died during follow-up, with 52.5% dying within 4 months after discharge. Serum NGAL (P <0.001), urine NGAL (P = 0.047), and urinary KIM-1 (P = 0.014) levels were significantly higher in deceased patients at discharge. After adjustment for eGFR, only urinary KIM-1 independently predicted mortality at month 4 (HR 3.166, 95%CI 1.203-8.334, P = 0.020) and month 12 (HR 1.969, 95%CI 1.123-3.454, P = 0.018) in Cox regression models. In ROC analysis urinary KIM-1 (AUC = 0.830) outperformed other markers of renal function. Kaplan-Meier survival analysis showed KIM-1 predictive value is additive to that of AKI incidence and admission eGFR. Admission serum NGAL was higher in AKI patients (P ≤0.001) with a modest diagnostic performance (AUC = 0.667), below urea (AUC = 0.732), creatinine (AUC = 0.696), or CysC (AUC = 0.676). Conclusions: Discharge urinary KIM-1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF

Valor pronóstico de la ratio urea / creatinina en la insuficiencia cardiaca descompensada y su relación con el daño renal agudo

Introducción: El empeoramiento de la función renal es un índice de mal pronóstico en pacientes con insuficiencia cardiaca aguda (ICA). El cociente urea/creatinina (U/C) podría tener significación pronóstica en la ICA. Material y métodos: Estudio observacional, prospectivo, cuyo objetivo fue analizar el valor pronóstico del cociente U/C, determinado en las primeras 24-48 h del ingreso, en pacientes hospitalizados por ICA, así como su relación con el filtrado glomerular estimado (FGe) y el daño renal agudo (DRA). Resultados: Se incluyeron un total de 204 pacientes, con edad media de 79, 3 años. La mediana de FGe fue 55 ml/min/1, 73m2. En el análisis multivariante, un cociente U/C > 50 se asoció con una mayor probabilidad de DRA durante el ingreso (36, 5% vs. 21, 9%) y mortalidad por cualquier causa (odds ratio [OR] 2, 75) y por IC (OR 3, 50) durante el seguimiento. La elevación del cociente U/C fue pronóstica solo en los pacientes con FGe normales (mortalidad 4, 4% vs. 22%; p=0, 01). La combinación del cociente U/C con el FGe tuvo mayor capacidad predictiva de DRA que cada uno de ellos por separado (área bajo la curva 0, 718, intervalo de confianza al 95% 0, 643-0, 793; p<0, 001). Conclusiones: Un cociente U/C > 50 predice mortalidad a largo plazo en pacientes con FGe normal, y combinado con el FGe, mejora la identificación del riesgo de DRA, en pacientes ingresados por ICA. Dado lo simple de este biomarcador, sugerimos su uso sistemático en la clínica diaria. Background: Worsening renal function is associated with an adverse prognosis for patients with acute heart failure (AHF). Urea-creatinine ratio (U:C ratio) might be useful for measuring renal function and could help stratify patients with AHF. Material and methods: An observational and prospective study was conducted to analyse the prognostic value of the U:C ratio, measured during the first 24-28 hours of admission, for patients hospitalised for decompensated Heart failure, and its relationship with estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI). Results: The study included 204 patients, with a mean age of 79.3 years, and a median eGFR of 55 mL/min/1.73m2. In the multivariate analysis, an U:C ratio above the median (50) was related to the development of AKI (36.5% vs. 21.9%) and to increased mortality, both overall (OR 2.75) and by HF (OR 3.50) in long term. In combination with eGFR, the U:C ratio showed prognostic value in patients with normal eGFR (mortality of 4.4% for an U:C ratio = 50 vs. 22% for U:C ratio &gt; 50; p=0.01), as well as a better predictive capacity for AKI than each of them separately (AUC, 0.718; 95% CI 0.643-0.793; p&gt;.000). Conclusions: An U:C ratio &gt; 50 is a predictor of increased long-term mortality for patients hospitalised for decompensated HF and with normal eGFR. Given the simplicity of this biomarker, its use in clinical practice should be more systematic

Effect of the Consumption of Alcohol-Free Beers with Different Carbohydrate Composition on Postprandial Metabolic Response; 35268021

Background: We investigated the postprandial effects of an alcohol-free beer with modified carbohydrate (CH) composition compared to regular alcohol-free beer. Methods: Two randomized crossover studies were conducted. In the first study, 10 healthy volunteers received 25 g of CH in four different periods, coming from regular alcohol-free beer (RB), alcohol-free beer enriched with isomaltulose and a resistant maltodextrin (IMB), alcohol-free beer enriched with resistant maltodextrin (MB), and a glucose-based beverage. In the second study, 20 healthy volunteers were provided with 50 g of CH from white bread (WB) plus water, or with 14.3 g of CH coming from RB, IMB, MB, and extra WB. Blood was sampled after ingestion every 15 min for 2 h. Glucose, insulin, incretin hormones, TG, and NEFAs were determined in all samples. Results: The increase in glucose, insulin, and incretin hormones after the consumption of IMB and MB was significantly lower than after RB. The consumption of WB with IMB and MB showed significantly less increase in glucose levels than WB with water or WB with RB. Conclusions: The consumption of an alcohol-free beer with modified CH composition led to a better postprandial response compared to a conventional alcohol-free beer. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Valor pronóstico de la ratio urea / creatinina en la insuficiencia cardiaca descompensada y su relación con el daño renal agudo

Introducción: El empeoramiento de la función renal es un índice de mal pronóstico en pacientes con insuficiencia cardiaca aguda (ICA). El cociente urea/creatinina (U/C) podría tener significación pronóstica en la ICA. Material y métodos: Estudio observacional, prospectivo, cuyo objetivo fue analizar el valor pronóstico del cociente U/C, determinado en las primeras 24-48 h del ingreso, en pacientes hospitalizados por ICA, así como su relación con el filtrado glomerular estimado (FGe) y el daño renal agudo (DRA). Resultados: Se incluyeron un total de 204 pacientes, con edad media de 79,3 años. La mediana de FGe fue 55 ml/min/1,73m2. En el análisis multivariante, un cociente U/C > 50 se asoció con una mayor probabilidad de DRA durante el ingreso (36,5% vs. 21,9%) y mortalidad por cualquier causa (odds ratio [OR] 2,75) y por IC (OR 3,50) durante el seguimiento. La elevación del cociente U/C fue pronóstica solo en los pacientes con FGe normales (mortalidad 4,4% vs. 22%; p=0,01). La combinación del cociente U/C con el FGe tuvo mayor capacidad predictiva de DRA que cada uno de ellos por separado (área bajo la curva 0,718, intervalo de confianza al 95% 0,643-0,793; p<0,001). Conclusiones: Un cociente U/C > 50 predice mortalidad a largo plazo en pacientes con FGe normal, y combinado con el FGe, mejora la identificación del riesgo de DRA, en pacientes ingresados por ICA. Dado lo simple de este biomarcador, sugerimos su uso sistemático en la clínica diaria

Valor pronóstico de la desnutrición en pacientes con insuficiencia cardíaca aguda y su influencia en la interpretación de marcadores de congestión venosa sistémica

Antecedentes La desnutrición es frecuente en los pacientes con insuficiencia cardíaca (IC). Dicha situación contribuye al incremento de la congestión sistémica dificultando el manejo clínico. Cuantificar la desnutrición y su relación con la congestión sistémica, es importante para optimizar el tratamiento durante la fase aguda. Material y métodos Estudio de cohortes retrospectivo en pacientes con diagnóstico de IC aguda. La población se estratificó según los índices de nutrición de CONUT (Controlling Nutritional Status) y PNI (Prognostic Nutritional Index) con el objetivo de analizar su relación con parámetros objetivos de congestión y el valor pronóstico al año de seguimiento. Resultados Se incluyeron un total de 309 pacientes, presentando más de la mitad algún grado de desnutrición al ingreso. El grado de congestión fue significativamente superior en los pacientes desnutridos, con una mayor proporción de «líneas b» y un mayor volumen plasmático relativo. Las concentraciones de la prohormona N-terminal del péptido natriurético cerebral (NT-proBNP), tanto al ingreso como al alta, también fueron significativamente superiores en los pacientes desnutridos, independientemente de la escala empleada. El análisis univariante identificó el índice de CONUT y PNI, como factores asociados a la mortalidad al año para todas las causas (HR 1, 62 [1, 22-2, 14]; p = 0, 001) y de PNI (HR 0, 65 [0, 53-0, 80]; p = < 0, 001), respectivamente. Conclusiones Un mayor grado de desnutrición (determinado mediante los índices de CONUT y PNI) en pacientes con IC aguda, se asoció a una mayor presencia de parámetros objetivos de congestión y a una mayor mortalidad al año para todas las causas. Background Malnutrition is frequent in patients with heart failure (HF) and contributes to increased systemic congestion, but also hinders its correct assessment, especially during decompensations. Estimating the degree of malnutrition and its relationship with systemic congestion is important to optimize treatment during decompensations. Material and methods Retrospective cohort study in patients with acute HF. The population was stratified according to CONUT (Controlling Nutritional Status) and PNI (Prognostic Nutritional Index) nutrition indices in order to analyse their relationship with objective parameters of congestion and the prognostic value of malnutrition. Results 309 patients were included. More than half presented some degree of malnutrition upon admission. The degree of congestion was significantly higher in malnourished patients, with a higher proportion of «comet tail artifacts» and a higher relative plasma volume. NT-proBNP concentrations, both on admission and at discharge, were also significantly higher in malnourished patients, regardless of the scale used. The univariate analysis identified the CONUT and PNI index as factors associated with one-year mortality from any cause (HR 1.62 [1.22-2.14]; p = 0.001) and PNI (HR 65 [0.53-0.80]; p = < 0.001), respectively. Conclusions A higher degree of malnutrition (determined by means of the CONUT and PNI indices) in patients with acute HF was associated with a higher presence of objective parameters of congestion and a higher one-year all-cause mortality