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Low Serum retinol-binding protein-4 levels in acute exacerbations of chronic obstructive pulmonary disease at intensive care unit admission is a predictor of mortality in elderly patients.

Jin Q, Chen Y, Lou Y, He X - J Inflamm (Lond) (2013)

Bottom Line: RBP4 levels were decreased by 30.6% in non-survivors compared with survivors (51.5 vs 74.2 mg/L, p < 0.001).RBP4 improved the prognostic accuracy of mortality for the APACHE II and SAPS II scores.Serum RBP4 levels are significantly reduced in elderly AECOPD patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, Editorial Board of the Chinese Journal of Emergency Medicine, The Second affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China. hexiaojun_hz@163.com.

ABSTRACT

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are thought to be associated with increased mortality in elderly patients. Low retinol-binding protein-4 (RBP4) is associated with a high risk of respiratory infections in the general population. Therefore, we hypothesized that low RBP4 levels are associated with an increased risk of AECOPD and can be used as a biomarker for AECOPD in elderly patients.

Methods: Enzyme-linked immunosorbent assays were used to assess RBP4 levels in elderly with AECOPD within the first 24 hours after intensive care unit admission. Forty-six elderly patients with stable COPD in outpatient clinics and 50 healthy elderly persons who had physical examinations as outpatients were controls.

Results: In AECOPD patients, RBP4 levels were lower than those in stable COPD patients and healthy controls (59.7 vs 91.2 and 113.6 mg/L, p < 0.001). RBP4 levels were decreased by 30.6% in non-survivors compared with survivors (51.5 vs 74.2 mg/L, p < 0.001). A higher Acute Physiology and Chronic Health Enquiry II (APACHE II) score and Simplified Acute Physiology score (SAPS II) were associated with lower RBP4 levels (r = -0.692, p = 0.024 and r = -0.670, p = 0.015, respectively). RBP4 was positively correlated with creatinine and body mass index, and negatively correlated with C-reactive protein and Global Initiative for Chronic Obstructive Lung Disease stage. Multivariate logistic regression showed that RBP4 was an independent mortality predictor of AECOPD (odds ratio: 0.926, p = 0.007). Analysis of the area under the receiver operating characteristic (AUC) curve showed that RBP4 showed good discrimination (AUC: 0.88; 95% confidence interval: 0.78-0.94; p = 0.008) in predicting mortality. RBP4 improved the prognostic accuracy of mortality for the APACHE II and SAPS II scores.

Conclusions: Serum RBP4 levels are significantly reduced in elderly AECOPD patients. RBP4 might be a good predictive biomarker for mortality in elderly AECOPD patients in the intensive care unit.

No MeSH data available.


Related in: MedlinePlus

Correlations between RBP4 levels and other risk factors. (a) Correlation between RBP4 levels and age (r = −0.002, p = 0.988). (b) Correlation between RBP4 levels and TB (total bilirubin) (r = −0.252, p = 0.011). (c) Correlation between RBP4 levels and sCr (r = 0.224, p = 0.005). (d) Correlation between RBP4 levels and BNP (r = −0.005, p = 0.958). (e) Correlation between RBP4 levels and ALB (r = 0.199, p = 0.057). (f) Correlation between RBP4 levels and BMI (r = 0.205, p = 0.043). (g) Correlation between RBP4 levels and CRP (r = −0.183, p = 0.044). (h) Correlation between RBP4 levels and PCT (r = −0.073, p = 0.472).
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Figure 3: Correlations between RBP4 levels and other risk factors. (a) Correlation between RBP4 levels and age (r = −0.002, p = 0.988). (b) Correlation between RBP4 levels and TB (total bilirubin) (r = −0.252, p = 0.011). (c) Correlation between RBP4 levels and sCr (r = 0.224, p = 0.005). (d) Correlation between RBP4 levels and BNP (r = −0.005, p = 0.958). (e) Correlation between RBP4 levels and ALB (r = 0.199, p = 0.057). (f) Correlation between RBP4 levels and BMI (r = 0.205, p = 0.043). (g) Correlation between RBP4 levels and CRP (r = −0.183, p = 0.044). (h) Correlation between RBP4 levels and PCT (r = −0.073, p = 0.472).

Mentions: RBP4 levels were not correlated with age in AECOPD (r = −0.002, p = 0.988) (Figure 3a). RBP4 levels were associated with liver, renal, and heart function. Liver function was identified as a strong predictor of RBP4 because RBP4 levels were directly correlated with parameters indicating the liver’s biosynthetic capacity, such as TB (r = −0.252, p = 0.011) (Figure 3b). RBP4 levels were also correlated with markers of renal failure, specifically sCr (r = 0.224, p = 0.005) (Figure 3c), but they were not correlated with BNP (r = −0.005, p = 0.958) (Figure 3d) and ALB (r = 0.199, p = 0.057) levels (Figure 3e). BMI had a significant effect on RBP4 levels in AECOPD patients (r = 0.205, p = 0.043) (Figure 3f). There was an inverse correlation between RBP4 levels and CRP levels (r = −0.183, p = 0.044) (Figure 3g), while no correlation between RBP4 and PCT levels was found (r = −0.073, p = 0.472) (Figure 3h).


Low Serum retinol-binding protein-4 levels in acute exacerbations of chronic obstructive pulmonary disease at intensive care unit admission is a predictor of mortality in elderly patients.

Jin Q, Chen Y, Lou Y, He X - J Inflamm (Lond) (2013)

Correlations between RBP4 levels and other risk factors. (a) Correlation between RBP4 levels and age (r = −0.002, p = 0.988). (b) Correlation between RBP4 levels and TB (total bilirubin) (r = −0.252, p = 0.011). (c) Correlation between RBP4 levels and sCr (r = 0.224, p = 0.005). (d) Correlation between RBP4 levels and BNP (r = −0.005, p = 0.958). (e) Correlation between RBP4 levels and ALB (r = 0.199, p = 0.057). (f) Correlation between RBP4 levels and BMI (r = 0.205, p = 0.043). (g) Correlation between RBP4 levels and CRP (r = −0.183, p = 0.044). (h) Correlation between RBP4 levels and PCT (r = −0.073, p = 0.472).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852419&req=5

Figure 3: Correlations between RBP4 levels and other risk factors. (a) Correlation between RBP4 levels and age (r = −0.002, p = 0.988). (b) Correlation between RBP4 levels and TB (total bilirubin) (r = −0.252, p = 0.011). (c) Correlation between RBP4 levels and sCr (r = 0.224, p = 0.005). (d) Correlation between RBP4 levels and BNP (r = −0.005, p = 0.958). (e) Correlation between RBP4 levels and ALB (r = 0.199, p = 0.057). (f) Correlation between RBP4 levels and BMI (r = 0.205, p = 0.043). (g) Correlation between RBP4 levels and CRP (r = −0.183, p = 0.044). (h) Correlation between RBP4 levels and PCT (r = −0.073, p = 0.472).
Mentions: RBP4 levels were not correlated with age in AECOPD (r = −0.002, p = 0.988) (Figure 3a). RBP4 levels were associated with liver, renal, and heart function. Liver function was identified as a strong predictor of RBP4 because RBP4 levels were directly correlated with parameters indicating the liver’s biosynthetic capacity, such as TB (r = −0.252, p = 0.011) (Figure 3b). RBP4 levels were also correlated with markers of renal failure, specifically sCr (r = 0.224, p = 0.005) (Figure 3c), but they were not correlated with BNP (r = −0.005, p = 0.958) (Figure 3d) and ALB (r = 0.199, p = 0.057) levels (Figure 3e). BMI had a significant effect on RBP4 levels in AECOPD patients (r = 0.205, p = 0.043) (Figure 3f). There was an inverse correlation between RBP4 levels and CRP levels (r = −0.183, p = 0.044) (Figure 3g), while no correlation between RBP4 and PCT levels was found (r = −0.073, p = 0.472) (Figure 3h).

Bottom Line: RBP4 levels were decreased by 30.6% in non-survivors compared with survivors (51.5 vs 74.2 mg/L, p < 0.001).RBP4 improved the prognostic accuracy of mortality for the APACHE II and SAPS II scores.Serum RBP4 levels are significantly reduced in elderly AECOPD patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, Editorial Board of the Chinese Journal of Emergency Medicine, The Second affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China. hexiaojun_hz@163.com.

ABSTRACT

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are thought to be associated with increased mortality in elderly patients. Low retinol-binding protein-4 (RBP4) is associated with a high risk of respiratory infections in the general population. Therefore, we hypothesized that low RBP4 levels are associated with an increased risk of AECOPD and can be used as a biomarker for AECOPD in elderly patients.

Methods: Enzyme-linked immunosorbent assays were used to assess RBP4 levels in elderly with AECOPD within the first 24 hours after intensive care unit admission. Forty-six elderly patients with stable COPD in outpatient clinics and 50 healthy elderly persons who had physical examinations as outpatients were controls.

Results: In AECOPD patients, RBP4 levels were lower than those in stable COPD patients and healthy controls (59.7 vs 91.2 and 113.6 mg/L, p < 0.001). RBP4 levels were decreased by 30.6% in non-survivors compared with survivors (51.5 vs 74.2 mg/L, p < 0.001). A higher Acute Physiology and Chronic Health Enquiry II (APACHE II) score and Simplified Acute Physiology score (SAPS II) were associated with lower RBP4 levels (r = -0.692, p = 0.024 and r = -0.670, p = 0.015, respectively). RBP4 was positively correlated with creatinine and body mass index, and negatively correlated with C-reactive protein and Global Initiative for Chronic Obstructive Lung Disease stage. Multivariate logistic regression showed that RBP4 was an independent mortality predictor of AECOPD (odds ratio: 0.926, p = 0.007). Analysis of the area under the receiver operating characteristic (AUC) curve showed that RBP4 showed good discrimination (AUC: 0.88; 95% confidence interval: 0.78-0.94; p = 0.008) in predicting mortality. RBP4 improved the prognostic accuracy of mortality for the APACHE II and SAPS II scores.

Conclusions: Serum RBP4 levels are significantly reduced in elderly AECOPD patients. RBP4 might be a good predictive biomarker for mortality in elderly AECOPD patients in the intensive care unit.

No MeSH data available.


Related in: MedlinePlus