The diagnostic usefulness of serum total bile acid concentrations in the early phase of acute pancreatitis of varied etiologies

The most common causes of acute pancreatitis (AP) are biliary tract diseases with cholestasis and alcohol consumption. In 10%–15% of patients, etiology determination is difficult. Identification of the etiology allows for the implementation of adequate treatment. The aim of this study was to assess the utility of the serum concentrations of total bile acids (TBA) to diagnose AP etiology in the early phase of the disease. We included 66 patients with AP, admitted within the first 24 h from the onset of symptoms. TBA were measured in serum at 24, 48, and 72 h from the onset of AP, using an automated fifth generation assay. The bilirubin-to-TBA ratio (B/TBA) was calculated. TBA was highest on the first day of AP and decreased subsequently. In patients with biliary etiology, serum TBA was significantly higher compared to those with alcoholic and other etiologies. B/TBA was significantly higher in patients with alcoholic etiology. At admission, the cut-off values of 4.7 µmol/L for TBA and 4.22 for the B/TBA ratio allowed for a differentiation between biliary and other etiologies of AP with a diagnostic accuracy of 85 and 83%. Both TBA and B/TBA may help in the diagnosis of AP etiology in the early phase of AP

Zonulin-related peptides in the setting of multiple myeloma — evaluation of a candidate molecule with respect to anemia, chronic kidney disease, and tumor burden: a pilot study

Introduction: The zonulin-related family of peptides is implicated in the regulation of intestinal permeability, inciting chronic inflammation and potentially in the incidence of cancer due to increased antigen trafficking. Scarce data are available on the potential role of serum zonulin-related peptides (ZRP) as biomarkers of hematologic cancer and related organ involvement.Objectives: This study aimed to evaluate correlations between ZRP as assessed by the commercially — available Immunodiagnostik enzyme-linked immunosorbent assay (ELISA) assay, complete blood count, multiple myeloma (MM) stage, and renal impairment among MM patients.Materials and methods: We analyzed a population of 73 patients with MM and evaluated the relationship between disease characteristics and long-term outcomes. The control group included 21 healthy volunteers (11 women, 10 men) between 24 and 69 years old. Serum ZRP were assayed using a commercially available kit (Immundiagnostik, Bergen, Germany).Results: Twenty-six patients had eGFR < 60 mL/min/1.73 m2. Median (IQR) serum concentration of ZRP in the studied group was 23.9 (19.9; 27.4) ng/mL. ZRP did not differ between subjects with and without anemia (defined as hemoglobin below the lower reference limit, p = 0.4). Significant correlations were detected with serum albumin (R = 0.30; p = 0.009), log (creatinine) (R = –0.28; p = 0.018), eGFR (R = 0.26; p = 0.025), ferritin (R = 0.34; p = 0.013), and log (NT-proBNP) (R = –0.32; p = 0.006). Moreover, in patients with symptomatic MM, ZRP correlated with monoclonal protein in serum (R = –0.29; p = 0.046), blood hemoglobin (R = 0.27; p = 0.027), and age (R = –0.24; p = 0.044). In multiple regression, serum concentrations of monoclonal protein and ferritin, as well as the International Staging System for multiple myeloma (ISS) stage 3, were identified as independent predictors of ZRP concentrations.Conclusions: Serum concentrations of zonulin-related peptides only weakly correlate with kidney failure (creatinine and eGFR) in MM patients and anemia (hemoglobin concentration) in symptomatic MM patients. Serum ZRP assay is of little benefit in the setting of MM, exhibiting only weak correlations with indices of organ involvement, and it cannot be used to assess prognosis in MM

The key role of hepcidin-25 in anemia in multiple myeloma patients with renal impairment

Background and objectives: Anemia is common in multiple myeloma (MM) and is caused by a complex pathomechanism, including impaired iron homeostasis. Our aim is to evaluate the biomarkers of iron turnover: serum soluble transferrin receptor (sTfR) and hepcidin-25 in patients at various stages of MM in relation with markers of anemia, iron status, inflammation, renal impairment and burden of the disease and as predictors of mortality. Materials and methods: Seventy-three MM patients (six with smoldering and 67 with symptomatic disease) were recruited and observed for up to 27 months. Control group included 21 healthy individuals. Serum sTfR and hepcidin were measured with immunoenzymatic assays. Results: MM patients with and without anemia had higher sTFR compared to controls, while only anemic patients had higher hepcidin-25. Both hepcidin-25 and sTfR were higher in anemic than non-anemic patients. Higher hepcidin-25 (but not sTfR) was associated with increasing MM advancement (from smoldering to International Staging System stage III disease) and with poor response to MM treatment, which was accompanied by lower blood hemoglobin and increased anisocytosis. Neither serum hepcidin-25 nor sTfR were correlated with markers of renal impairment. Hepcidin-25 predicted blood hemoglobin in MM patients independently of other predictors, including markers of renal impairment, inflammation and MM burden. Moreover, both blood hemoglobin and serum hepcidin-25 were independently associated with patients’ 2-year survival. Conclusions: Our results suggest that hepcidin-25 is involved in anemia in MM and its concentrations are not affected by kidney impairment. Moreover, serum hepcidin-25 may be an early predictor of survival in this disease, independent of hemoglobin concentration. It should be further evaluated whether including hepcidin improves the early diagnosis of anemia in MM