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Prague, Czech Republic

Malina P.,Nemocnice Pisek a.s. | Cejp V.,Chirurgicke oddeleni | Jabor A.,Pracoviste Laboratornich Metod
Klinicka Biochemie a Metabolismus | Year: 2012

Objective: Our retrospective study aimed to evaluate the contribution of interleukin-6 in severe acute pancreatitis. Mortality of severe acute pancreatitis ranges from 10-20% (for sterile necrosis, SN) to 20-85% (infected necrosis, IN). Resolution of SN and IN is clinically very important, but often difficult and therefore they are still searching for new laboratory markers for their differentiation. Design: Retrospective descriptive observational study of cases series. Methods: 59 patients hospitalized with severe acute pancreatitis (Atlanta classification 1992) in the surgery department of Hospital Písek in the 2000-2006 were included. Regularly they were investigated by C-reactive protein (CRP) and interleukin-6 (IL-6), sufficient data was in 42 patients: 14 with IN (identified microbiologically or according to computed tomography, CT), 28 with SN. Statistical analysis was performed using Fisher's test and chi-square test. Results: There was found statistically significant discriminatory ability of daily averages of IL-6 5th and 6 th + 7th and 8th day of hospitalization between the IN and SN (p = 0.0014 for day 5 and 6, respectively. p = 0.0009 for day 7 and 8). Developing IN realistically set in the most between 5th and 9th day (needle biopsy with identification of microbiological agents or CT signs of infection). The ability of CRP to discriminate SN and IN was not found, the levels were between 2nd to 8th days increased steadily. The run of the concentrations of IL-6 was characteristic, where at the admission there was present significant elevation irrespective of subsequent development of IN and from the second day of hospitalization it decreased significantly. Further increase in IL-6 was present only in patients with the development of IN. For the cut-off (discrimination of SN and IN) for IL-6 (valid from 5th of hospitalization) 100 ng/L was P<0.005, for 150 ng/L P<0.01. Conclusion: Interleukin-6 in our retrospective study showed a statistically significant ability to discriminate between infected and sterile necrosis in severe acute pancreatitis. For the cut-off of IL-6 effective from 5th day of hospitalization 100 ng/L was P <0.005, for 150 ng/L was P<0.01. Source


Salek T.,University of Ostrava | Franekova J.,Pracoviste Laboratornich Metod | Franekova J.,Charles University | Jabor A.,Pracoviste Laboratornich Metod | And 2 more authors.
Klinicka Biochemie a Metabolismus | Year: 2016

The total testing process consists of five phases: pre-preanalytical (test selection), preanalytical, analytical, postanalytical and post-postanalytical (clinical work with laboratory test results). The major tools of postanalytical and post-postanalytical phases are: reference ranges, cut-off and action points, calculation of important indicators and graphic visualization, autovalidation, interpretative comment, reflexive and reflective testing, clinical examination of the patient with record in documentation, reporting of critical values and effective transmission of laboratory test results by laboratory information systems. The European Federation of Clinical Chemistry and Laboratory Medicine proposed quality indicators of postanalytical phase. The post-postanalytical phase currently has a great potential to be an important part of clinical biochemistry and other disciplines of laboratory medicine. Source


Hejlova I.,Klinika Hepatogastroenterologie | Komrskova J.,Pracoviste Laboratornich Metod | Sticova E.,Pracoviste Klinicke a Experimentalni Patologie | Trunecka P.,Klinika Hepatogastroenterologie | And 2 more authors.
Gastroenterologie a Hepatologie | Year: 2016

Introduction: Some enzymes, e.g., aspartate aminotransferase (AST), can form high molecular mass complexes, referred to as macro enzymes, which persist in the serum and cause increased serum activity. Case study: We describe two cases of isolated chronically elevated AST activity in two young asymptomatic females (20- and 21-years-old). Both patients denied alcohol consumption, use of medication, or increased muscle activity. ALT activity and other initial laboratory studies were normal. Detailed investigation did not reveal any disease of liver, muscles, heart, or thyroid gland, or the presence of celiac disease. This led us to consider the possibility of macro-AST. A polyethylene glycol precipitation assay was performed, which revealed 92% and 79% polyethylene glycol precipitable activity, confirming the presence of macro-AST in both patients. Conclusion: Isolated chronically elevated AST activity may be caused by the presence of macro-AST. Confirmation of macro-AST positivity may help avoid expensive and invasive investigations. Source


Objective: The aim of the study was to analyze the distribution of values obtained from the oral glucose tolerance test (oGTT) in adults and pregnant women, to define approaches to the interpretation of the measured values, to determine the benefits of a collection carried out one hour after glucose load for the gestational diabetes mellitus (GDM) diagnostics. Methods: A total of 2043 oGTT results were obtained (samples of fasting blood glucose and 2 hours after a 75-gram glucose load were drawn), of which 676 results were based on three collections (fasting, one hour and two hours after glucose load). Altogether, 806 oGTT results were obtained in adults and 62 in children. Results: The oGTT results obtained in pregnant women and in other adult patients are substantially different. The identification of GDM depends on the cut-off values used and on the method of interpretation; in our monitored set, the identification of GDM was in the range of 3.7% to 9.6%. The prediction of oGTT pathology using fasting glucose (cut-off 5.6 mmol/l) shows low effectiveness in pregnant women but has sufficient effectiveness in adults. The implementation of blood collection one hour after glucose load during oGTT in pregnant women can significantly increase the chance of detection of pathological results. Conclusions: It is necessary that the screening of all pregnant women should be performed; the standard oGTT (75 g of glucose) approved by the WHO can be used for this purpose. The procedure designed for the diagnostics of GDM is based on three samples (fasting, one hour and two hours after glucose load). The cut-off values in pregnant women will be subjected to modifications in the future; the lowering of these values is expected. It is recommended that the oGTT should be repeated within 6 weeks after delivery; should the result be negative, the follow-up check should be implemented every three years afterwards. Source


Authors followed the article "Estimated glomerular filtration rate in diabetic patients" published by Šálek, T. and Ponížil, P. We expanded original data set (N=565) with additional 950 examinations and compared equations for glomerular filtration rate estimation (eGFR) from KDIGO 2012 Guidelines (equation CKD-EPI, version 2009 for creatinine only, version 2012 for cystatin C only and version 2012 for the combination of creatinine + cystatin C). Authors concluded, that CKD-EPI equations offer different results in different intervals of glomerular filtration. Cystatin C based equation (CKD-EPI 2012, cystatin C) offers higher values of eGFR in the interval above 1.5 ml/s per 1.73 m2 in comparison to the equation CKD-EPI 2009 (creatinine) and vice versa in the interval below 1.5 ml/s per 1.73 m2. Combined equation CKD-EPI 2012 (creatinine + cystatin C) is more related to the concentration of cystatin C than to the concentration of creatinine. These results may have impact on the interpretation and strategy of GFR estimation in clinical practice. Source

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