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Firenze, Italy

Claudia C.,Azienda Ospedaliero | Claudia R.,Azienda Ospedaliero | Agostino O.,General Laboratory of Clinical Biochemistry | Agostino O.,Laboratorio Generale | And 2 more authors.
Journal of Trauma - Injury, Infection and Critical Care | Year: 2011

Background: Head injury represents one of the most important and frequent traumatic pathology in the emergency department. Among the different risk factors, preinjury use of warfarin has received considerable attention in trauma literature. The aim of this study was to identify further risk indicators of intracranial hemorrhage (ICH) to improve risk stratification of warfarinized patients with minor head injuries. Methods: Medical records of 1,554 adult patients with minor head injuries evaluated by the Emergency Department of Azienda Ospedaliera, Universitaria Careggi from January 2007 to February 2008 were analyzed retrospectively. All the patients included in the study were subjected to blood tests. The international normalized ratio (INR) measured on admission was correlated with the results of head computed tomography scan. Results: Of the 1,410 patients included in the study, 75 (5.2%) were warfarin anticoagulated at the time of trauma. The INR measured on admission was 2.37 ± 1.04 (mean ± standard deviation), and this value was significantly associated with occurrence of ICH after head trauma (r = 0.37; p < 0.005). For 12 (of 75) patients of this group, the findings of the computed tomography scans were positive. The receiver operating characteristic curve show that the most effective INR cutoff value was 2.43, with a sensitivity of 92%, a specificity of 66%, and positive and negative predictive values of 33% and 97%, respectively. Conclusion: This study highlights the strong relationship between INR values and the probability of ICH, as shown in previous studies. The high negative predictive value of the identified cutoff, if confirmed, could be used to exclude ICH. Copyright © 2011 by Lippincott Williams & Wilkins.

Mussap M.,Uoc Medicina Of Laboratorio | Graziani M.S.,Azienda Ospedaliera Universitaria Integrata di Verona | Caldini A.,Laboratorio Generale | Dolci A.,UOC Patologia Clinica | Merlini G.,University of Pavia
Biochimica Clinica | Year: 2014

The contrast media, widely used in imaging diagnostics, show a favorable safety profile. As the presence of pre-existing disease is considered a risk factor for adverse events, patients should be carefully evaluated prior to the procedure. The aim of this consensus document is to recommend appropriate biochemical tests to be performed for an early recognition of individuals at higher risk of contrast media nephrotoxicity. This condition is defined by an increase of serum creatinine concentrations of at least 0.50 mg/dL and/or 25% within 3-4 days from contrast media exposure. The most important risk factor is renal insufficiency [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or serum creatinine >1.50 mg/dL]. Other risk factors are age >75 years, dehydration, diabetes, heart failure and anemia. Monoclonal gammopathies, multiple myeloma, Waldenström macroglobulinemia and amyloidosis are not considered risk factors per se. On the basis of available guidelines, it is recommended: a) prior to the examination, to measure serum creatinine baseline with a method traceable to the international reference measurement system and report its concentration together with the eGFR using the Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) equation; b) for monitoring, to measure serum creatinine more than once calculating the delta from the baseline value: if serum creatinine increases >5%, repeat the test within 48- 72 h. Performing of laboratory tests to exclude the presence of monoclonal gammopathies (i.e., serum protein electrophoresis, Bence Jones protein determination, serum free light chain measurements) is not required.

Pezzati P.,Laboratorio Generale | Balboni F.,Laboratorio Analisi Chimico Cliniche
Biochimica Clinica | Year: 2015

Copeptin (CP) is a 39 amino acid glycopeptide including the C-terminal domain of the arginine-vasopressine precursor. CP is known to be a stable and sensitive surrogate marker for arginine-vasopressine release and it has been investigated as possible diagnostic and prognostic marker in cardiovascular and cerebrovascular diseases. In particular, the role of CP in the early diagnosis of acute myocardial infarction has been widely investigated and various systematic reviews are currently available. CP associated with cardiac troponin T has been reported to carry a good diagnostic accuracy. These data need, however, to be revised according to the introduction of highly sensitive assays for measuring troponins. Although some evidence on the prognostic value of CP in various cardiovascular frameworks is available, natriuretic peptides maintain a leading role. The research on CP is currently investigating its prognostic value in stroke and transient ischemic attack. However, due to the small sample size of studies and the lack of sound evidence, there are no minimal indications for requesting CP in this framework.

The IMWG has recently updated the disease definition of multiple myeloma, by adding validated biomarkers to the existing requirements of organ damage (hypercalcemia, renal insufficiency, anemia, bone lesions). These changes are based on the identification of biomarkers able to detect the subset of patients with smouldering multiple myeloma at imminent risk of developing organ damage and should, therefore, be considered for therapy. Considering that the clinical laboratory is involved in the measurement of these new markers, this paper is aimed to illustrate the proposed changes giving at the same time some indications for their accurate measurements. As for the organ damage, the major change is related to the evaluation of renal function: the new criteria include the estimation of the glomerular filtration rate using established formulas (eGFR) rather than the use of serum creatinine concentrations alone, as previously indicated. The diagnosis of renal insufficiency requires an eGFR <40 mL/min/1.73 m2. The criteria for anemia and hypercalcemia remain unchanged. As biomarker of malignancy, a ratio >100 of involved to uninvolved serum free light chains is recognized. Another relevant modification is the elimination of the monoclonal protein quantification; it is based on the consideration that an important percentage of patients with multiple myeloma does not show a serum or urine monoclonal protein. Other changes based on imaging techniques or bone marrow examination do not involve the clinical laboratory and are not discussed in this paper. Additional biomarkers will probably be indentified in the near future, but they need to be validated by more independent studies. © 2015 Biochimica Clinica.

We present here a recommendation for the urine albumin measurement in diabetic nephropathy. The suggestions are derived from those by the IFCC-National Kidney Disease Education Programme (NKDEP) Working Group on Standardization of Urine Albumin Assays (WG-SAU) and are based on the best available evidence. They cover preanalytical, analytical, and post-analytical phases.

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