Serumska endotelna lipaza, lipidni i upalni pokazatelji u bolesnika s akutnim zatajivanjem srca i metaboličkim sindromom [Serum endothelial lipase, lipids and inflammatory markers in acute heart failure patients with metabolic syndrome]

Potočnjak, Ines (2016) Serumska endotelna lipaza, lipidni i upalni pokazatelji u bolesnika s akutnim zatajivanjem srca i metaboličkim sindromom [Serum endothelial lipase, lipids and inflammatory markers in acute heart failure patients with metabolic syndrome]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The study aimed to investigate whether patients with acute heart failure and concomitant metabolic syndrome have worse outcome, longer hospitalisation, higher in-hospital and three-month follow-up mortality; severity of clinical presentation, levels of endothelial lipase, lipids and inflammatory markers; whether female patients have worse clinical presentation and more comorbidities. The study was performed as a prospective, single-centre, observational research on 152 patients, defined and categorised according to the ESC and ACCF/AHA Guidelines for HF. Mean age was 75.2 years (SD 10.3), 52% female, mean BMI 28.8 kg/m2 (SD 5.4). Hospital mortality was 14.5%, three-month 27.4%, length of hospitalisation 11.34 (SD 9.26) days. Patients with metabolic syndrome and women had higher endothelial lipase. Higher total cholesterol and LDL were associated with lower in-hospital and three-month follow-up mortality. Lower HDL and higher IL-6 were associated with higher three-month mortality. Results of this study suggest that „Obesity paradox“ and „Reverse epidemiology“ emerged. Patients with metabolic syndrome were longer hospitalised, however patients without metabolic syndrome had higher odds ratio of in-hospital and three-month mortality. Female gender was not associated with higher mortality. To conclude, results emphasise importance of diagnosing metabolic syndrome, hypolipemic therapy re-evaluation and continuous development of diagnostic biomarkers.

Abstract in Croatian

Cilj je istraživanja utvrditi rezultiraju li bolesnici s akutnim zatajivanjem srca i udruženim metaboličkim sindromom lošijim ishodom, duljom hospitalizacijom, većom bolničkom i tromjesečnom smrtnosti; težinu kliničke slike; koncentracije endotelne lipaze, lipidnog profila i upalnih pokazatelja; te imaju li bolesnice ženskog spola težu kliničku sliku i brojnije komorbiditete. Istraživanje je provedeno kao prospektivno, jednocentrično, opservacijsko na 152 bolesnika. Bolesnici su definirani prema ESC i ACCF/AHA Smjernicama za srčano zatajivanje. Srednja dob bila je 75,2 godina (SD 10,3), 52% su bile žene, srednji ITM bio je 28,8 kg/m2 (SD 5,4). Bolnička smrtnost bila je 14,5%, tromjesečna 27,4%, duljina hospitalizacije bila je 11,34 (SD 9,26) dana. Bolesnici s metaboličkim sindromom i žene imali su višu endotelnu lipazu. Viši ukupni kolesterol i LDL povezan je s manjim izgledom bolničke i tromjesečne smrtnosti. Niži HDL i viši IL-6 su povezani s većim izgledom tromjesečne smrtnosti. Rezultati upućuju na pojavu „Paradoksa pretilosti“ i „Obrnutu epidemiologiju“. Bolesnici s metaboličkim sindromom bili su dulje hospitalizirani, međutim bolesnici bez metaboličkog sindroma imali su veći izgled bolničke i tromjesečne smrti. Ženski spol nije povezan s višim mortalitetom. Zaključno, rezultati upućuju na važnost dijagnosticiranja metaboličkog sindroma, reevaluacije hipolipemičke terapije i kontinuirani razvoj dijagnostičkih biomarkera.

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