Concentrations of IL-18 in patients with rheumatoid arthritis — a preliminary study

Objectives. Interleukin-18 (IL-18) is a representative proinflammatory cytokine that plays an important role in the pathogenesis of rheumatoid arthritis (RA). The objective of this study was to evaluate the concentration of IL-18 in patients with RA in relation to RF IgM and anti-cyclic citrullinated peptide antibodies (anti-CCP2). Design and methods. 75 patients with diagnosed RA (aged 20–80 years) treated with non-steroidal anti-inflammatory (NSAIDs) and disease modifying anti-rheumatoid drugs (DMARDs) and 52 age-matched controls were included. Results. IL-18 concentration was almost sixfold higher in RA patients in comparison with the reference group (235 pg/mL v. 39 pg/mL). The association between IL-18 and RF IgM and anti-CCP was found. Conclusions. Serum IL-18 level seems to be positively related to the increased RF IgM and anti-CCP concentrations in patients with established rheumatoid arthritis.

Occurrence of hyperlipidemia in relation to body mass index in school children aged 9–11

Background. There is a link between lipid disorders and body mass and the occurrence of cardiovascular diseases. This study aimed at establishing the prevalence of lipid abnormalities in relation to body mass in children aged 9–11. Materials and methods. The study involved 232 presumably healthy school children aged 9-11. Fasting venous blood samples were taken from every child to assess the lipid profile: total cholesterol (TC), LDL cholesterol (LDL-C, direct measurement), HDL cholesterol (HDL-C) and triglycerides (TG). Anthropometric measurements were performed including height and weight, followed by calculating the body mass index (BMI) by using an online “OLAF” calculator. Results. The prevalence of hypercholesterolemia and an elevated concentration of LDL-C in the group of children was high and equaled 51.1% and 34.6%, respectively. Hypertriglyceridemia in the respective age groups of 9 and 10–11 years was found to be: 41.6% and 27.7%. Only in 9.5% of children the level of HDL-C was lower than optimal. The percentage of overweight was two-fold higher among boys than in girls (13.6 v. 6.9%), similarly the percentage of obesity was higher in boys compared with that in girls (15.5 v. 10.3%). Conclusions. In school children aged 9–11 the dominant and most frequent lipid abnormality, not associated with an increased body mass, was hypercholesterolemia followed by hypertriglyceridemia. Overweight and obesity were strongly related to gender and much more frequent among boys. There should be more attention paid to dyslipidemia and body weight already in childhood in the context of health policy and prevention

How Do Apolipoproteins ApoB and ApoA-I Perform in Patients with Acute Coronary Syndromes

Acute coronary syndromes are the leading cause of hospitalization and death. Results from recent stu - dies suggest that apolipoprotein measurement and apoB: apoA-I are superior to traditional lipids in the estimation of coro nary risk. We compared apolipoprotein concentrations and apoB:apoA-I with traditional lipid measures and athe ro - genic indices in patients diagnosed with acute coronary syndromes (ACS) within 6 hrs from the onset of chest pain. A study group consisted of 227 patients diagnosed with ACS (STEMI=60, NSTEMI=66 and UA=105). Clinically healthy volunteers (n=85) served as controls. Measure ments of cardiac TnI, lipid profile, hsCRP, apolipoprotein A-I and apoB100 were performed and apoB:apoA-I, TC-HDL-C, LDL-C:HDL-C ratios were calculated. Patients had increased LDL-C (>3.0 mmol/L) and non-HDL-C (>3.4 mmol/L). Triglycerides were below the cut-off value, but patients had significantly higher TG concentrations and lower HDL-C compared to controls (p<0.001). Apo B and apoA-I con - cen tration in patients remained within the accepted range. Atherogenic indices TC:HDL-C, LDL-C:HDL-C and apoB: apoA-I were significantly increased in patients. ApoB:apoA-I ratio in ACS males was within low risk whereas in females corresponded to medium risk. ApoB:apoA-I and LDL-C:HDLC ratios were of good diagnostic utility for discrimination between patients and controls (AUC 0.71 and 0.79; respec - tively). ApoB:apoA-I and LDL-C:HDL-C were of very good diagnostic utility for discrimination between STEMI patients and controls (AUC 0.80 and 0.84). We could not show the superiority of apoB:apoA-I over LDL-C:HDL-C as the discr i - Introduction According to data published in the National Reg - istry of Acute Coronary Syndromes (PL-ACS) every year in Poland 140.000 subjects are diagnosed with acute coronary syndromes (ACS) (1). Acute coronary syndromes are a group of disorders developing as a consequence of atherosclerosis and characterized by changes in the coronary circulation, whose common feature is the significant reduction or cessation of blood flow in the coronary arteries. The most com - mon cause of circulatory disorders is a blood clot formed at the rupture of atherosclerotic plaque. No vel cardiac biomarkers are used to identify patients with ACS even when there is no evidence of cardio my ocyte damage (myeloperoxidase, ischemia-modi fied albu - min, heart-fatty acid binding protein). Simi la rly, novel biomarkers are assessed that may be re gar ded as risk discriminators of cardiovascular disease (CVD) with a predictive value for future events. Apolipoprotein B (apo B) and apolipoprotein A-I (apo A-I), either sepa - rately or together as a cal cu lated apoB:apoA-I ratio, may predict CVD risk more accurately than traditional lipid pro file measurement. Each proatherogenic lipoprotein fraction: VLDL, IDL, and LDL contains one apo B molecule per par - ticle, therefore the serum concentration of apo B re - flects the total number of atherogenic particles (2). HDL is the only antiatherogenic lipoprotein and its major structural protein is apo A-I. This protein pro - duced both in the liver and intestine is involved in reverse cholesterol transport carrying excess choles - terol from peripheral tissues back to the liver for ex - cretion (3). In spite of the availability of standardized com - mer cial assays, apo B and/or apoA-I are not yet widely measured in routine medical laboratory prac tice. Data sug gest that measurement of apo B po ten tially could pro vide several advantages over the con ventional measu re ment of LDL-cholesterol (LDL-C) and non- HDL-C as a cardiovascular disease risk in dex. Apo B can be mea sured directly and with a high accuracy and pre cision in the nonfasting state (4). The reliability and reproducibility of apo B assays are comparable to those expected for non-HDL-C, a meas ure of all the cholesterol in atherogenic lipo proteins (5). The optimal value for LDL-cholesterol (LDL-C) is <2.6 mmol/L, for non-HDL-C it is <3.4 mmol/L and the opti mal apo B concentration is <0.9 g/L (6). Results above these values indicate an increased risk of CVD including acute coronary syndromes. Even the most accurate determinations of LDL-C or non- HDL-C, obta ined after calculation of other para me - ters, do not fully reflect the proatherogenic impact of apo B containing lipoproteins. Studies showed that in sub jects with normal or slightly increased concen - trations of LDL-C, apo B is a better indicator of CVD risk. This comes from the fact that even with a slightly elevated concentration of LDL-C in the blood, with conco mittant hypertriglyceridemia and low HDL-C, very often an increase of small dense LDL particles occurs (7). Small dense LDL have up to 25% lower cho lesterol content per one apo B molecule than large LDL particles (8). Cardiovascular risk is more directly related to the number and size of atherogenic parti cles than to their cholesterol concentration (4, 7, 9). The concentration of apo AI in the circulation is approximately 1–1.3 g/L, and the majority of this protein (99%) is a part of HDL. Concentration of apo A-I below 1.2 g/L is related to greater risk of CVD (10). The cholesterol content of HDL particles is influ enced by blood triglyceride concentration and in, general, hypertriglyceridemia is associated with low HDL-C and low apo A-I values (11, 12). The most use ful as a predictor of CVD risk seems to be the cal culated apoB:apoA-I ratio (13). Previous reports have shown that an apoB:apoA-I ratio of <0.7 and <0.6 for men and women respectively is associated with low risk for cardiovascular disease. ApoB:apoA-I corresponds to the relationship between proathero genic apo B-con - taining lipoproteins and anti-athero genic HDL fraction (13). The advantage of calcula ting this ratio is that the concentrations of both apo lipoproteins are not influ - enced by a nonfasting state and during daytime. In addi tion, with regard to the tests performed after acute coronary syndromes have occurred, it does not matter how much time has elap sed since the blood collection. This is a valuable piece of information, because in pa - tients sus pected with ACS the credibility of lipid mea - surement is questioned if the blood was collected within 24 hours after the incident. Results from recent studies suggested that the se rum concentration of apo B and apo A-I as well as the apoB:apoA-I ratio are related to the occurrence of ACS in different ethnic populations (8). We aimed to com pare apolipoprotein concentrations and the apoB: apoA-I ratio with the traditional lipid measures in patients diag nosed with acute coronary syndromes. 238 Sypniewska et al.: Apolipoproteins B and A-I in acute coronary syndromes mination power of both was almost identical. Determination of apolipoproteins should not be recommended for routine clinical use, however, incorporating apoB and apoB:apoA-I into risk assessment could provide additional important information on cardiovascular risk

The performance of triglyceride to high-density lipoprotein cholesterol ratio in acute coronary syndromes using a diagnostic decision tree

Background. Modern modeling techniques, including decision trees, may potentially provide accurate prediction and classification of outcomes, and support the process of clinical decision making. The objective of our study was to evaluate the performance of triglyceride to high-density lipoprotein (TG:HDL-C) ratio in acute coronary syndromes (ACS) presented using a decision tree analysis. Methods. The initial study group consisted of 220 consecutive patients admitted to hospital within the first 6 hours from the onset of chest pain. All these patients met clinical criteria of ACS and were compared with 116 healthy volunteers in a case-control study. Serum was assayed on admission for cardiac troponin I, C-reactive protein, apolipoproteins ApoAI and ApoB, and lipid parameters. Atherogenic lipid ratios: TC:HDL:C, LDL-C:HDL:C and TG:HDL-C were calculated. Results. ACS patients showed almost twice as high median values of TG:HDL-C as controls [2.77 (1.88–4.08) vs. 1.47 (0.99–2.08); p &lt; 0.0001]. The TG:HDL-C ratio was significantly related to the positive history of coronary artery disease, age and lipid parameters, except for LDL-C. The TG:HDL-C ratio was, after age, the most powerful independent predictor and classifier of the occurrence of ACS with the optimal cutoff being 2.28. The performance of TG:HDL-C was superior to other lipid parameters and ratios, and enabled identification of the additional 6 subjects with ACS. Conclusion. The TG:HDL-C ratio is a useful risk marker of the ACS occurrence. Further prospective studies are needed to confirm our findings and clarify the interaction between TG and HDL-C concentrations in ACS patients

Value of C-Reactive Protein as a Risk Factor for Acute Coronary Syndrome: A Comparison with Apolipoprotein Concentrations and Lipid Profile

Objective. To investigate whether assessment of C-reactive protein (CRP) and apolipoproteins, besides the traditional lipid profile, enhances the assessment process for the risk of acute coronary syndrome (ACS). Methods. The study group consisted of 220 consecutive patients admitted to hospital within the first 6 hours from the onset of chest pain. Patients were diagnosed with unstable angina (n = 96), non-ST-elevation myocardial infarction (NSTEMI; n = 57), or ST-elevation myocardial infarction (STEMI; n = 67). ACS patients were compared with 116 healthy volunteers in a case-control study. The serum was assayed on admission for CRP, apolipoproteins ApoAI and ApoB100, and lipid parameters. Results. The highest concentrations of CRP were found in NSTEMI and STEMI, with a median value four-fold higher in ACS patients than in controls (P < 0.0001). Only CRP significantly increased the probability of ACS development (adjusted odds ratio for a 1 mg/L increase 1.90; 95% confidence interval [CI] 1.34–2.89) and explained 90% of the variation for ACS development. Similarly, we demonstrated the highest diagnostic accuracy for CRP among all investigated markers (area under the curve 0.80; 95% CI 0.75–0.85). Conclusions. Our study indicates that CRP superiorly to apolipoproteins and lipid profile facilitates the risk stratification for ACS occurrence

Diagnostic efficacy ofmyeloperoxidase for the detection of acute coronary syndromes

Background Early diagnosis of acute coronary syndrome (ACS) is frequently a challenging task, while immediate risk stratification remains crucial for the prompt implementation of appropriate therapy in this setting. Employing markers that increase rapidly after the symptom onset may enhance triage and therapeutic decisionmaking in patients suspected for ACS. Myeloperoxidase (MPO) exerting proinflammatory and pro-oxidative properties is suggested as a reliable early marker for ACS associated with unfavourable clinical outcome. We assessed the diagnostic efficacy of plasma MPO alone or in combination with cardiac troponin I (cTnI) for detecting ACS in patients presenting with chest pain initiating within 6 h before the hospital admission. Material and methods A study group consisted of 253 patients diagnosed with ACS and 47 subjects having other heart disease or unspecified chest pain. Clinically healthy volunteers (n = 124) served as controls. MPO concentration was measured in plasma (Abbott Diagnostics, USA), while serum was assayed for cTnI, creatine-kinase MB, lipids, glucose, creatinine, brain natriuretic peptide type B and C-reactive protein. Results Both MPO and cTnI values were significantly lower in non-ACS subjects than in patients with ACS. At 97Æ5th percentile as cut-off, the superiority of MPO over cTnI was observed in patients with unstable angina and non-ACS subjects. Considerably higher MPO concentrations were demonstrated in the troponin-negative ACS patients on admission who became troponin-positive after 6 h. Combined evaluation of MPO and cTnI possessed remarkably higher sensitivity than assessment of cTnI alone in all patients with ACS. Conclusions Myeloperoxidase substantially facilitates the early diagnosis of ACS. Keywords Acute coronary syndrome, cardiac troponin I, chest pain, diagnostic efficacy, myeloperoxidase. Eur J Clin Invest 2011; 41 (6): 667–67

Serum 25(OH)D status and lipid profile in children with newly diagnosed asthma

Background. The problem of the influence of hyperlipidemia on asthma was addressed several years ago. Systematic review and meta-analysis performed in the pediatric population on the association between vitamin D status and lipid profile components revealed discordant results and indicated that higher serum 25(OH)D is related to a more favorable lipid profile. Objective. We aimed to elucidate whether there was an association between vitamin D status and lipid profile components and apolipoprotein B in a sample of children with newly diagnosed atopic asthma. Methods. The study included 150 children aged 2–12 years. Atopic asthma was diagnosed in 110 children; 40 children constituted a reference group. Fasting blood was collected to measure 25(OH)D total, lipid profile and apolipoprotein B concentrations. Results. Children with asthma had significantly lower 25(OH)D (p &lt; 0.0001) but similar lipid and apolipoprotein B concentrations. The proportions of hypercholesterolemia, hypertriglyceridemia and increased apoB concentrations were similar in both groups. HDL-C concentrations in asthmatic 25(OH)D-deficient children were higher compared with the children with sufficient levels (p = 0.05). ApoB concentration was lower in 25(OH)D-deficient compared with vitamin D sufficient asthmatics (p = 0.0008). Correlations between 25(OH)D concentration and lipids and apoB in asthmatics revealed gender differences. An inverse relationships between vitamin D and total cholesterol and HDL-C (R= –0.39, p &lt; 0.05; R= –0.475, p &lt; 0.001) were found in girls. In boys vitamin D correlated with LDL-C and apoB (R = 0.376, R = 0.498; p &lt; 0.001). Conclusion. In children with asthma lower 25(OH)D had more favorable gender-dependent effect on the lipid profile. The association of serum 25(OH)D and lipid levels in children with asthma remains for further studies.

25-hydroxyvitamin D insufficiency in children with newly diagnosed asthma

Background. 25-hydroxyvitamin D [25(OH)D] deficiency seems to be related to the development of asthma. Any evaluation of the relationship between asthma and 25(OH)D deficiency must consider the association between increased airway responsiveness, eosinophil counts and serum immunoglobulin E (IgE), and 25(OH)D as a potential player in airway remodelling. Objective. We assessed the association of 25(OH)D with markers of atopy and eosinophilic inflammation in children with newly diagnosed asthma. Methods. The study included 165 children aged 2–12 years. The diagnosis of asthma was performed by an experienced paediatric pulmonologist. Allergic asthma was diagnosed in 106 children, and non-allergic asthma in ten; in 49 children, asthma was excluded. Fasting blood was collected for cell counts, and serum was obtained to measure lipids, C-reactive protein (hsCRP), 25(OH)D and IgE. Results. Children with asthma had significantly lower 25(OH)D (p &lt; 0.001). Both groups had similar lipid values. Elevated total IgE concentration and eosinophil counts were found in asthmatics; neutrophils were similar in asthmatic and reference groups. There was a strong tendency to higher eosinophil counts in 25(OH)D-deficient children (&lt; 20 ng/mL) with atopic asthma (p &lt; 0.08). Conclusion. In children with asthma, 25(OH)D insufficiency/deficiency is associated with higher eosinophil counts and IgE. 25(OH)D monitoring is important in the prevention and management of children with asthm

ARCHITECT STAT High Sensitive Troponin I Familiarization Study (FAM) in the Department of Laboratory Medicine, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Poland

Background. International guidelines recommend the use of cardiac troponin assays for early detection of acute myocardial infarction. New high-sensitivity assays along with improved precision and sensitivity, are now widely available, accelerating patient’s diagnosis, treatment and invasive therapy. In this study we evaluated analytical performance of the Abbott ARCHITECT STAT high-sensitive troponin-I immunoassay and its 99th percentile upper reference limit. Methods. We performed the analytical evaluation of the hs-cTnI assay using Abbott ARCHITECT i2000SR immunoanalyzers. Features of the assay including imprecision, detection limits, linearity of dilution, interferences and method comparisons were assessed, as well as the 99th percentile upper reference limits in a cohort of 427 presumably healthy individuals were established. Results. Total imprecision ranged from 3.1% to 4.7% and was lowest for the medium controls. The observed limit of blank, limit of detection and limit of quantitation assumed values of 0.1, 1.5 and 4.8 ng/L, respectively. Common interferences, sample dilution and carry over did not affect the hs-cTnI results. Hs-cTnI was detectable in 98% of presumably healthy individuals. The 99th percentile values were age and sex dependent in the presumably healthy, but not in the healthy individuals. Conclusion. The new high-sensitivity troponin-I assay has improved analytical features and may be a valuable diagnostic tool.

Fluorescence lifetime of collagen degradation products in plasma of patients with left ventricular remodeling

Background. The concentration of collagen degradation products in plasma may reflect the process of left ventricular remodeling in patients after acute myocardial infarction. The aim of this study was to confirm that mean fluorescence lifetime of plasma is decreased in patients with left ventricular systolic dysfunction. Patients, materials and methods. The study group consisted of patients treated with primary percutaneous coronary intervention for acute myocardial infarction admitted to the Department of Cardiology and Internal Medicine at the University Hospital in Bydgoszcz. The overall group comprised of 65 patients. From each patient 8 mL of blood was taken to obtain plasma that was used for further examination. The time-resolved spectrometer Life Spec II with the sub-nanosecond pulsed 360 nm EPLED® diode was used in order to measure fluorescence lifetime of samples. Results. Significant differences were observed in mean fluorescence lifetime of plasma between groups of patients divided according to brain natriuretic peptide levels. Statistical analysis showed that the increase in brain natriuretic peptide level is an independent factor resulting in the decrease in mean fluorescence lifetime. Conclusions. It seems that plasma concentration of collagen degradation products is closely related to brain natriuretic peptide level. However, this experiment confirmed that plasma of patients with potential high probability of developing left ventricular remodeling is characterized by the decrease in mean fluorescence lifetime