Incremento del índice neutrófilo linfocito como predictor del deterioro de la función renal en pacientes con enfermedad renal crónica

Determinar si el incremento del índice neutrófilo linfocito (INL) es un predictor del deterioro de la función renal en pacientes con enfermedad renal crónica (ERC). Metodología: Se analizó una cohorte retrospectiva de 316 pacientes con ERC subdivididos en dos grupos: quiénes presentaban INL ≥ 2,09 (elevado) y los que tenían INL 1 ml/min/ 1,73 m2 y se relacionó con covariables intervinientes. Se realizó análisis bivariado y multivariado calculando el riesgo relativo con intervalos de confianza al 95%, considerando asociación significativa si el valor p <0,05. Resultados: 123 (79,7%) pacientes con INL elevado y 34 (21,5%) pacientes con INL no elevado presentaron deterioro de función renal (p<0,001). El RRa de deterioro de función renal en pacientes con INL elevado fue 3,23 (IC: 95%: 2,32-4,49). Las covariables relacionadas a deterioro de función renal fueron ERC en estadio IV (RRa:1,31, IC95%: 1,02-1,69, p=0,037), anemia (RRa: 1,39, IC95%: 1,15-1,69, p=0,001) , antecedente de enfermedad cardiovascular (RRa: 1,31, IC 95%: 1,06-,1,69, p=0,017) y albuminuria ( RRa: 1,78 , IC 95%: 1,22-2,08, p=0,021). Conclusiones: El incremento del índice neutrófilo linfocito es un predictor de deterioro de función renal en pacientes con enfermedad renal crónica.To determine if the increase in the neutrophil-lymphocyte index is a predictor of renal function deterioration in patients with chronic kidney disease. Methodology: We analyzed a retrospective cohort of 316 patients with CKD subdivided into two groups: those with NLI (neutrophils/lymphocytes index) ≥ 2,09 (elevated) and those with NLI 1 ml/min/ 1,73 m2 and related them to other covariates. Bivariate and multivariate analysis was performed by calculating the relative risk with 95% confidence intervals, considering the association significant if the p-value was <0,05. Results: 123 (79,7%) of patients with elevated NLI and 34 (21,5%) patients with non-elevated NLI presented deterioration of renal function (p<0,001). The RRa of renal function deterioration in patients with elevated NLI was 3,23 (95% CI: 2,32-4,49). The covariates related to renal function deterioration were stage IV CKD (RRa=1,31, 95% CI: 1,02-1,69, p=0,037) , anaemia (RRa= 1,39, 95% CI: 1,15-169, p=0,001) ,history of cardiovascular disease (RRa: 1.31, 95% CI: 1,06-1,69, p=0.017) and albuminuria ( RRa= 1,78 , 95% CI: 1,22-2,08 , p=0,021). Conclusions: Increased neutrophil-lymphocyte ratio is a predictor of renal function deterioration in patients with chronic kidney diseaseTesi

Neutropenia congénita grave con transformación leucémica en un paciente pediátrico. Reporte de un caso

Background: Severe congenital neutropenia is defined as neutrophil count less than 500 cells/mm3, it is characterized by presenting repeated infections in different organs since the first months of life, in addition to the risk of developing leukemic transformation. Case report: A 7-month-old infant presented with recurrent abscesses since the first month of life, progressive neutropenia in the hemogram, later acute myeloid leukemia was diagnosed by flow cytometry, and finally died of septic shock. Conclusion: Infant with congenital neutropenia developed a leukemic transformation not associated to previous treatment with granulocyte stimulating factor (G-CSF). More studies are expected in the future to determine which other factors besides G-CSF are involved in the leukemic transformation of patients with congenital neutropenia in order to provide better diagnostic and therapeutic alternatives in patients affected by this disease.Introducción: La neutropenia congénita grave se define como el recuento de neutrófilos inferior a 500 células/mm3, se caracteriza por presentar infecciones a repetición en diferentes órganos desde los primeros meses de vida, además del riesgo de desarrollar una transformación leucémica. Reporte de caso: Lactante de 7 meses quien presentó abscesos a repetición desde el primer mes de edad, en el hemograma se evidenció neutropenia grave, posteriormente se diagnosticó leucemia mieloide aguda por citometría de flujo, finalmente falleció por choque séptico. Conclusión: Lactante con neutropenia congénita desarrolló una transformación leucémica no asociada a tratamiento previo con factor estimulante de granulocitos (G-CSF), se espera contar en un futuro con más estudios para poder determinar qué otros factores además del G-CSF están implicados en la transformación leucémica de los pacientes con neutropenia congénita para poder brindar mejores alternativas diagnósticas y terapéuticas en los pacientes afectados por esta enfermedad

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk