Diagnostic value of cystatin C in patients with drug-resistant pulmonary tuberculosis receiving palliative care

Authors

  • O. M. Raznatovska Zaporizhzhia State Medical University, Ukraine,
  • H. V. Khudiakov Zaporizhzhia State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2019.2.161488

Keywords:

drug-resistant tuberculosis, palliative care, cystatin C

Abstract

 

To date there are no data on the study of heart failure early diagnostic criteria in patients with pulmonary drug-resistant tuberculosis (DRTB) available in the literature.

The purpose of the work is to determine the level of serum cystatin C in patients with pulmonary DRTB receiving palliative care and to establish the diagnostic value of this indicator in the early diagnosis of heart failure.

Materials and methods. Patients of the main group received palliative care were divided into 2 groups depending on the body mass index (BMI): the main group 1 consisted of 26 patients with BMI ≤18.1 kg/m2, the main group 2 was composed of 26 patients with BMI >18.1 kg/m2. The control group included 29 patients who received antimycobacterial therapy by category 4 according to the drug resistance profile. The level of serum cystatin C was measured by an enzyme-linked immunosorbent assay (ELISA) using the kit “Human Cystatin C ELISA BioVendor Research and Diagnostic Products” (ng/ml; Czech Republic). The serum level of TNF-α was studied by ELISA in a reader Sirio S using the kit “Bender MedSystems GmbH” (Austria), (pkg/ml). The results of the study were processed on a personal computer using statistical software package Statistica, version 13 (Copyright 1984–2018 TIBCO Software Inc. All Rights reserved. License No. JPZ8041382130ARCN10-J).

Results. In patients with pulmonary DRTB receiving antimycobacterial therapy, the level of cystatin C exceeds the upper limit of the normal reference values, and in palliative care DRTB patients with BMI >18.1 kg/m2 it is 10,4 % higher than in pulmonary DRTB patients receiving antimycobacterial therapy. At the same time, in patients with pulmonary DRTB receiving antimycobacterial therapy, an increase in serum cystatin C level is significantly associated with a decrease in serum TNFα levels and an increase in BMI. In palliative care patients with DRTB and BMI >18.1 kg/m2, an increase in serum cystatin C levels significantly depends directly on a decrease in serum TNFα. And in palliative care patients with pulmonary DRTB and BMI ≤18.1 kg/m2, a decrease in cystatin C level significantly depends directly on a decrease in BMI and inversely depends on an increase in serum TNFα level, which leads to a significant decrease in the overall quality of life score and heart failure progression.

Conclusions. In palliative care patients with DRTB and BMI >18.1 kg/m2, increased level of cystatin C can serve as an early marker of heart failure development. In palliative care patients with DRTB and BMI ≤18.1 kg/m2, low level of cystatin C can serve as a marker of secondary cardiovascular disease development and heart failure progression.

 

References

Voronenko, Yu. V., Gubskiy, Yu. I., & Tsarenko, A. V. (2014). Stvorennia systemy palіativnoi ta hospіsnoi dopomohy v umovakh reformuvannia okhorony zdorovia v Ukrainі: medychnі ta sotsіalnі aspekty [Creating of the hospice and palliative care system in the conditions of health care reform in ukraine: medical and social aspects]. Nauka і praktyka. Mіzhvіdomchyi medychnyi zhurnal, 1(2), 63–75. [in Ukrainian].

Raznatovskaya, E. N. (2013). Analiz prichin smerti bol'nykh khimiorezistentnym tuberkulezom legkikh [Analysis of causes of death in patients with resistant pulmonary tuberculosis]. Klinicheskaya infektologiya i parazitologiya, 2(05), 29–39. [in Russian].

Bilovol, А. N., Mykhailova, Yu. А., Petyunina, O.V., & Lapshina, L. A. (2012). Osobennosti kardiogemodinamiki, izmenenij markerov disfunkcii pochek i citokinogeneza pri khronicheskoj serdechnoj nedostatochnosti i khronicheskoj serdechnoj nedostatochnosti v sochetanii s khronicheskoj bolezn'yu pochek [The peculiarities of cardiac hemodynamics, changes of markers of kidney dysfunction and immune inflammation in chronic heart failure and in chronic heart failure accompanied by chronic kidney disease]. Ukrainskyj terapevtychnyj zhurnal, 3–4, 20–25. [in Russian].

Velkov, V. V. (2011). Cistatin S – novye vozmozhnosti i novye zadachi dlya laboratornoj diagnostiki [Cystatin C: the new opportunities and new goals for laboratory diagnostics (part 3)]. Laboratornaya diagnostika, 2(56), 31–37. [in Russian].

Alehagen, U., Dahlström, U.  Lindahl, T. L. (2009). Cystatin C and NT-proBNP, a powerful combination of biomarkers for predicting cardiovascular mortality in elderly patients with heart failure: results from a 10-year study in primary care. Eur. J. Heart. Fail., 11(4), 354–360. doi: 10.1093/eurjhf/hfp024

Battistoni, A., Rubbatu, S.,  Volpe, M. (2012). Circulating biomarkers with preventive, diagnostic and prognostic implications in cardiovascular diseases. Int J Cardiol, 157(2), 160–8. doi: 10.1016/j.ijcard.2011.06.066

Toft, I., Solbu, M., Kronborg, J., Mathisen, U. D., Eriksen, B. O., Storhaug, H. et al. (2012). Cystatin C as a risk factor cardiovascular events and all-cause mortality in the general population. Nephrol Dial Transplant, 27(7), 2780–7. doi: 10.1093/ndt/gfr751.

Raznatovska, O. M.,  Khudiakov, G. V. (2018). Factors of chemoresistant pulmonary tuberculosis progression in patients receiving palliative treatment. Zaporozhye medical journal, 20, 3(108), 388–391. doi: 10.14739/2310-1210.2018.3.130829

(2014). Ukraina. MOZ. Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy doroslym. Tuberkulioz : nakaz MOZ Ukrainy vid 31 hrudnia 2014 r. №620 [Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care for adults "Tuberculosis" : Order of the Ministry of Health of Ukraine from December 31 2014 №620]. [in Ukrainian].

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1.
Raznatovska OM, Khudiakov HV. Diagnostic value of cystatin C in patients with drug-resistant pulmonary tuberculosis receiving palliative care. Zaporozhye Medical Journal [Internet]. 2019Apr.2 [cited 2024Dec.24];(2). Available from: http://zmj.zsmu.edu.ua/article/view/161488

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