Lactate dehydrogenase (LDH) is prognostic for acute live failure (ALF) when used in a new version of the model for end-stage liver disease (MELD) score known as the MELD-LDH, new research confirms (JALM 2023; doi: 10.1093/jalm/jfac137).
To confirm previous proteomics findings in a small study, the researchers reviewed laboratory data from 238 patients with biochemical evidence of ALF admitted to a single medical center over 12 months. The researchers also reviewed laboratory data from a subset of 170 patients with encephalopathy.
LDH was strikingly elevated in nonsurvivors at the time of peak injury. Receiver operative curve characteristic (ROC) curve analyses revealed that LDH by itself could discriminate between survivors and nonsurvivors on the first day of hospitalization, although not as well as the MELD and MELD-LDH scores.
LDH by itself performed similarly to the MELD at the time of peak injury, while the MELD-LDH score moderately outperformed both. The MELD-LDH score had greater sensitivity and negative predictive value than the MELD and King’s College Criteria (KCC). Plasma ALT values were similar between survivors and nonsurvivors and failed to discriminate between the two groups.
LDH was significantly higher in nonsurvivors and performed as well as the MELD score at peak injury. Furthermore, the MELD-LDH score outperformed both LDH and the MELD, with area under the curve of 0.77, compared with 0.82 for the MELD and MELD-LDH, respectively, on the day of peak ALT.
When the researchers compared sensitivity, specificity, and predictive values for death for the KCC using an LDH cutoff of 2,000 U/L, a MELD cutoff of 30 derived from previous literature, and a MELD-LDH at a proposed cutoff of 0.3, the KCC displayed the greatest specificity but poor sensitivity. KCC specificity was 11% and 45% on the first day and the day of peak injury, respectively.
MELD-LDH had greater sensitivity at day of peak, 89%, and negative predictive value (NPV) of 93, than either the LDH or MELD alone. At peak injury day, LDH had sensitivity of 72% and negative predictive value of 46 and MELD alone had sensitivity of 76 and NPV of 85. The researchers say these figures show that MELD-LDH is better at identifying patients who need a liver transplant.
When researchers limited their analyses to only patients who meet standard criteria for ALF by virtue of their encephalopathy and no chronic illness, results were similar.
These results confirm that LDH is prognostic in ALF patients, with similar performance to the MELD, the researchers wrote. They added that the new MELD-LDH score moderately increases sensitivity for death, and therefore transplant need, over the MELD. Although additional confirmatory studies are needed, the researchers state that careful use of these risk stratification tools might improve decision-making and donor organ allocation.
PLASMA BIOMARKER MAY HELP DISTINGUISH TYPES OF DEMENTIA
Measuring plasma placental grown factor (PlGF)—a molecule that prompts development of new blood vessels—may help determine whether cognitive problems in older adults result primarily from vascular problems or another cause, such as Alzheimer disease, according to a recent study (Alzheimers Dement 2023; doi: 10.1002/alz.12974). Researchers found that patients with higher plasma PlGF levels are more likely to have cognitive impairment or evidence of brain injury.
Clinicians typically rely on imaging to determine whether older adults’ cognitive impairments are mostly caused by Alzheimer’s disease or vascular issues. In response, the MarkVCID Consortium has worked to identify biomarkers of vascular drivers of cognitive impairment. It determined that PGIF may be useful for identifying patients whose cognitive impairment stems from vascular brain injury.
In the current study, researchers at five sites studied 355 patients who had blood collection, imaging, and cognitive testing.
Patients with blood PlGF measurements in the top quartile were three times as likely to have cognitive impairment or dementia than patients in the bottom quartile. Every unit increase in total PlGF in the blood was associated with a 22% increase in the likelihood of having cognitive impairment and a 16% increase in the likelihood of having imaging evidence of cerebral small vessel disease.
Plasma PlGF may function as a stable, reliable, and accurate diagnostic tool to identify patients whose cognitive impairment has suspected vascular causes, the authors wrote. The biomarker’s accuracy increases across progressive stages of brain injury.
They added that plasma PlGF may be a useful adjunct in evaluating subjects with suspected vascular cognitive impairment and/or dementia. The researchers called for more research to determine how well the biomarker can prospectively predict future cognitive decline.
The researchers noted that their study was limited by low enrollment at some sites and random resampling into equal cohorts. Another limitation was lack of measures for comorbid Alzheimer’s disease that may have limited plasma PlGF's ability to distinguish vascular contributions to dementia subtypes.
DIABETES AND OBESITY ROSE AMONG YOUNG ADULTS
The burden of most cardiovascular risk factors—some shown by lab values—is rising among young adults in the United States. The most affected racial and ethnic groups are Blacks, Hispanics, and Mexican Americans (JAMA 2023; doi: 10.1001/jama.2023.2307).
Declines in overall U.S. cardiovascular mortality have stagnated in the past decade, in part due to worsening risk-factor control in older adults. However, little is known about prevalence, treatment, and control of these risk factors in young adults ages 20−44.
Researchers performed a serial cross-sectional analysis of National Health and Nutrition Examination Survey data from 2009−2010 to 2017−March 2020 for this age group. They sought to identify national trends in prevalence of hypertension, diabetes, hyperlipidemia, and obesity, as well as smoking rates.
The researchers also sought to determine rates of hypertension and diabetes treatment and among those who received treatment, degree of blood pressure, and glycemic control.
The researchers found diabetes prevalence rose from 3.1% to 4.1% and hypertension from 9.3% to 11.5%. Prevalence of hyperlipidemia decreased from 40.5% to 36.1%. Black young adults had the highest rates of hypertension, while increases in hypertension occurred among Mexican Americans and other Hispanics. Mexican Americans had a significant rise in diabetes rates, from 4.3% to 7.5%.
Blood pressure control did not change much among those young adults treated for hypertension, but glycemic control was suboptimal for the entire study period, with about 1 in 2 adults with diabetes on therapy.