The clinical significance of insulin-like growth factor-1 and cystatin C in predicting the risk of developing complications of chemoresistant pulmonary tuberculosis in patients undergoing palliative treatment

Authors

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

DOI:

https://doi.org/10.14739/2310-1210.2019.3.169095

Keywords:

drug-resistant tuberculosis, palliative care, insulin-like growth factor-1, cystatin C

Abstract

In contemporaryUkraine, the urgency of pulmonary chemoresistant tuberculosis (CRTB) problem is evident as it is the cause of severe clinical condition, subjective and functional disorders causing disease-specific distress in patients. This disease is a common cause of palliative treatment (PT) for patients requiring professional medical care. The goal of PT for patients with pulmonary CRTB should be to improve the quality of life (QoL) by priority of stress reduction which occurred as a result of the underlying disease complications.

The purpose – to evaluate the clinical relevance of insulin-like growth factor-1 (IGF-1) and cystatin C for predicting the risk of pulmonary CRTB complications among patients in PT.

Materials and methods. The study enrolled 81 patients with pulmonary CRTB who were treated in a Communal Institution “Zaporizhzhia Regional Hospital” and a Specialized Tuberculosis Hospital at the State Institution “Sophia penal colony (№ 55)” of the Ministry of Justice of Ukraine in the Zaporizhzhia Region. All patients (100 %) were male. The main group consisted of 52 patients receiving PT, the average age was 35.0 (28.0; 51.7) years. The control group included 29 patients receiving antimycobacterial therapy (AMBT) by category 4 according to the drug resistance profile. Study groups were age- and gender-matched. Serum levels of cystatin C and IGF-1 were measured by an enzyme-linked immunosorbent assay (ELISA) with an immunoassay reader “Sirio S” using the kit “Human Cystatin C ELISA BioVendor Research and Diagnostic Products” (ng/ml; Czech Republic) and “Human IGF-1 ELISA” (ng/ml, Germany), respectively. The measurements were performed in the Immuno-enzymatic Laboratory of the Training Medical Laboratory Center of ZSMU.

Results. Among the patients with pulmonary CRTB who received the PT, high inflammatory process activity, pronounced decrease in the quality of life and underweight as well as decrease in serum concentrations of cystatin C and IGF-1 were determined 1 month after the beginning of inpatient treatment. It was found that palliative patients who died the following month after being treated in the hospital compared to those who continued the PT, showed 1,6 times increased serum level of TNF-α, a tendency to further decrease in both cystatin C and IGF-1 serum levels to 1572.8 (911.6; 2278.8) ng/ml and 5.0 (2.1; 6.4) ng/ml, respectively. The decrease in serum concentrations of these indicators was significantly correlated with all the studied parameters in palliative patients with pulmonary CRTB both, who continued the treatment and who died. At the same time, in palliative patients who died, a decrease in serum levels of cystatin C and IGF-1 was strongly correlated with a decrease in the quality of life: (r = 0.927; P = 0.01) and (r = 0.820; P = 0.01), respectively. The average body mass index (BMI) was 18.0 (15.8; 20.1) kg/m2 in these patients indicating the prevalence of underweight among them, and the high direct correlation between BMI and low serum concentrations of IGF-1 (r = 0.986; P = 0.01) and cystatin C (r = 0.728; P = 0.05) was indicative of a close relationship between cachexia and a decrease in the levels of anabolic processes impairment biochemical marker (IGF-1) and early marker of heart failure (cystatin C). Autopsy-identified causes of these patients death were heart failure and cachexia on the background of a specific process. A direct correlation was also found between decreased serum concentrations of IGF-1 and cystatin C in palliative patients with pulmonary CRTB both, who continued the treatment and those who died: (r = 0.901; P = 0.01) and (r = 0.732; P = 0.05), respectively.

Conclusions. Determination of IGF-1 and cystatin C serum concentrations has a great clinical significance in predicting the risk of complications such as heart failure and cachexia in patients with pulmonary CRTB receiving palliative treatment.

 

References

(2011). YeAPD. Bila knyha standartiv z paliatyvnoi dopomohy. Rekomendatsii Yevropeiskoi Asotsiatsii paliatyvnoi dopomohy [The White Book on Palliative Care Standards. Recommendations of the European Palliative Care Association] Retrieved from http://ligalife.com.ua/2011/paliativna/standart/ 4parent-kontekstta-metodologiya/. [in Ukrainian].

(2013). YeAPD. Prazka khartiia «Otrymannia paliatyvnoi dopomohy – pravo liudyny» [Prague Charter "Getting Palliative Care – Human Rights"]. Retrieved from http://eapcspeaksrussian. eu.aspx. [in Ukrainian].

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

Mangileva, T. A., & Gafarova, N. H. (2015). Metabolicheskie i gemodinamicheskie e'ffekty sistemy gormon rosta – insulinopodobnyj faktor rosta [The metabolic and hemodynamic effects of a growth hormone system are insulin-like growth factor]. Terapevticheskij arkhiv, 12, 128–133. [in Russian]. doi: 10.17116/terarkh20158712128-133

Harmatina, O. Yu. (2015). Insulinopodobnyj faktor rosta-1: nejrofiziologicheskie aspekty [Insulin like growth factor-1: neurophysiological aspects]. Medychna gidrologiia ta reabilitatsiia, 13, 1–3, 67–71. [in Russian].

Puche, J. E.  Castilla-Cortazar, E. (2012). Human conditions of insulin-like growth factor-1 (IGF-1) deficiency. J Transl Med., 10, 224. doi: 10.1186/1479-5876-10-224

Dronova, A. V., Grineva, E. N., Sitnikova, M. Yu.  Shlyakhto, E. V. (2010). Sistema gormona rosta – insulinopodobnyj faktor rosta-1 na raznykh e'tapakh techeniya khronicheskoj serdechnoj nedostatochnosti [The system of growth hormone - insulin-like growth factor-1 at different stages of the course of chronic heart failure [Sistema gormona rosta – insulinopodobnyi faktor rosta-1 na raznykh etapakh techeniya khronicheskoi serdechnoi nedostatochnosti]. Arterial'naya gipertenziya, 16(3), 299–304. [in Russian]. https://doi.org/10.18705/1607-419X-2010-16-3-299-304

Kravchun, P. G., Lapshina, L. A., Zolotajkina, V. I.  Borzova, E. Yu. (2015). Poterya massy tela i kakheksiya [Loss of body weight and cachexia]. Novosti mediciny i farmacii, 6(535), 22–27. [in Russian].

Velkov, V. V. (2011). Cistatin C – novye vozmozhnosti i novye zadachi dlya laboratornoj diagnostiki [Cystatin C: the new opportunities and goals for laboratory diagnostics]. Laboratornaya diagnostika, 2(56), 32–48. [in Russian].

Kurkina, T. V.  Shemetova, G. N. (2013). Diagnosticheskoe znachenie cistatina C u bol'nykh gipertonicheskoj bolezn'yu i ozhireniem [The diagnostic value of cystatin C in patients with hypertension and obesity]. Byulleten' medicinskikh Internet-konferencij, 3(3), 545–546. [in Russian].

Naruse, H., Ishii, J., Kawai, T., Hattori, K., Ishikawa, M., Okumura, M., et al. (2009). Cystatin C in acute heart failure without advanced renal impairment. Am J Med, 122(6), 566–573. doi: 10,1016 / j.amjmed.2008.10.042

Ministerstva okhorony zdorov’ia Ukrainy (2014). Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy doroslym. Tuberkuloz : zatverdzheno nakazom MOZ Ukrainy vid 31.12.2014 r. №620 [Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care for adults "Tuberculosis"]. [in Ukrainian].

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

Downloads

How to Cite

1.
Raznatovska OM, Khudiakov HV. The clinical significance of insulin-like growth factor-1 and cystatin C in predicting the risk of developing complications of chemoresistant pulmonary tuberculosis in patients undergoing palliative treatment. Zaporozhye Medical Journal [Internet]. 2019May31 [cited 2024Dec.25];(3). Available from: http://zmj.zsmu.edu.ua/article/view/169095

Issue

No. 3 (2019)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)