The Roles of Vitamin D Levels, Gla-Rich Protein (GRP) and Matrix Gla Protein (MGP), and Inflammatory Markers in Predicting Mortality in Intensive Care Patients: A New Biomarker Link?

IF 3.4 3区生物学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY

Metabolites Pub Date : 2024-11-13 DOI:10.3390/metabo14110620

Fatih Seğmen, Semih Aydemir, Onur Küçük, Recep Dokuyucu

{"title":"The Roles of Vitamin D Levels, Gla-Rich Protein (GRP) and Matrix Gla Protein (MGP), and Inflammatory Markers in Predicting Mortality in Intensive Care Patients: A New Biomarker Link?","authors":"Fatih Seğmen, Semih Aydemir, Onur Küçük, Recep Dokuyucu","doi":"10.3390/metabo14110620","DOIUrl":null,"url":null,"abstract":"Objectives: Identifying reliable biomarkers to predict mortality in critically ill patients is crucial for optimizing management in intensive care units (ICUs). Inflammatory and metabolic markers are increasingly recognized for their prognostic value. This study aims to evaluate the association of various inflammatory and metabolic markers with ICU mortality.Methods: This prospective observational study was conducted from January 2023 to January 2024 in the City Hospital's ICU. A total of 160 critically ill patients were enrolled. Laboratory parameters, including white blood cell (WBC) count, red cell distribution width (RDW), platelet count, neutrophil count, mean platelet volume (MPV), monocyte count, lymphocyte count, procalcitonin (PCT), C-reactive protein (CRP), calcium (Ca++), and vitamin D levels, were analyzed. Additionally, ratios such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory index (SII), and pan-immune-inflammation value (PIV) were calculated. Plasma levels of Gla-rich protein (GRP) and dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) were measured using ELISA.Results: The mean age of the patients included in the study was 60.5 ± 15.8 years. Cardiovascular disease was present in 72 patients (45%), respiratory system disease in 58 (36%), and chronic kidney disease (CKD) in 38 (24%). Additionally, 61 patients (38%) had diabetes, and 68 (42%) had hypertension. Inflammatory markers, including PLR, NLR, and PIV, were all significantly higher in non-survivors, while calcium and vitamin D levels were lower (p < 0.05). Higher WBC, RDW, neutrophil count, PLR, NLR, PIV, CRP, procalcitonin, GRP, and dp-ucMGP levels were positively correlated with longer hospital stays and increased mortality. In contrast, platelet and lymphocyte counts were negatively correlated with both outcomes (p < 0.05). Vitamin D levels showed an inverse relationship with both hospital stay and mortality, indicating that lower levels were associated with worse outcomes (p < 0.05). In multiple logistic regression analysis, elevated WBC count (OR = 1.20, p = 0.02), RDW (OR = 1.35, p = 0.01), neutrophil count (OR = 1.25, p = 0.01), MPV (OR = 1.20, p = 0.02), PLR (OR = 1.30, p = 0.01), NLR (OR = 1.40, p = 0.001), PIV (OR = 1.50, p = 0.001), CRP (OR = 1.32, p = 0.01), procalcitonin (OR = 1.45, p = 0.001), GRP (OR = 1.40, p = 0.001), and dp-ucMGP (OR = 1.30, p = 0.001) levels were significantly associated with increased mortality.Conclusions: Inflammatory and metabolic markers, particularly NLR, PLR, PIV, GRP, and dp-ucMGP, are strong predictors of mortality in ICU patients. These markers provide valuable insights for risk stratification and early identification of high-risk patients, potentially guiding more targeted interventions to improve outcomes.","PeriodicalId":18496,"journal":{"name":"Metabolites","volume":"14 11","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596285/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Metabolites","FirstCategoryId":"99","ListUrlMain":"https://doi.org/10.3390/metabo14110620","RegionNum":3,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"BIOCHEMISTRY & MOLECULAR BIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: Identifying reliable biomarkers to predict mortality in critically ill patients is crucial for optimizing management in intensive care units (ICUs). Inflammatory and metabolic markers are increasingly recognized for their prognostic value. This study aims to evaluate the association of various inflammatory and metabolic markers with ICU mortality.

Methods: This prospective observational study was conducted from January 2023 to January 2024 in the City Hospital's ICU. A total of 160 critically ill patients were enrolled. Laboratory parameters, including white blood cell (WBC) count, red cell distribution width (RDW), platelet count, neutrophil count, mean platelet volume (MPV), monocyte count, lymphocyte count, procalcitonin (PCT), C-reactive protein (CRP), calcium (Ca⁺⁺), and vitamin D levels, were analyzed. Additionally, ratios such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory index (SII), and pan-immune-inflammation value (PIV) were calculated. Plasma levels of Gla-rich protein (GRP) and dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) were measured using ELISA.

Results: The mean age of the patients included in the study was 60.5 ± 15.8 years. Cardiovascular disease was present in 72 patients (45%), respiratory system disease in 58 (36%), and chronic kidney disease (CKD) in 38 (24%). Additionally, 61 patients (38%) had diabetes, and 68 (42%) had hypertension. Inflammatory markers, including PLR, NLR, and PIV, were all significantly higher in non-survivors, while calcium and vitamin D levels were lower (p < 0.05). Higher WBC, RDW, neutrophil count, PLR, NLR, PIV, CRP, procalcitonin, GRP, and dp-ucMGP levels were positively correlated with longer hospital stays and increased mortality. In contrast, platelet and lymphocyte counts were negatively correlated with both outcomes (p < 0.05). Vitamin D levels showed an inverse relationship with both hospital stay and mortality, indicating that lower levels were associated with worse outcomes (p < 0.05). In multiple logistic regression analysis, elevated WBC count (OR = 1.20, p = 0.02), RDW (OR = 1.35, p = 0.01), neutrophil count (OR = 1.25, p = 0.01), MPV (OR = 1.20, p = 0.02), PLR (OR = 1.30, p = 0.01), NLR (OR = 1.40, p = 0.001), PIV (OR = 1.50, p = 0.001), CRP (OR = 1.32, p = 0.01), procalcitonin (OR = 1.45, p = 0.001), GRP (OR = 1.40, p = 0.001), and dp-ucMGP (OR = 1.30, p = 0.001) levels were significantly associated with increased mortality.

Conclusions: Inflammatory and metabolic markers, particularly NLR, PLR, PIV, GRP, and dp-ucMGP, are strong predictors of mortality in ICU patients. These markers provide valuable insights for risk stratification and early identification of high-risk patients, potentially guiding more targeted interventions to improve outcomes.

查看原文本刊更多论文

维生素 D 水平、富la 蛋白 (GRP) 和基质la 蛋白 (MGP) 以及炎症标志物在预测重症监护患者死亡率中的作用：新的生物标志物联系？

目的：确定预测重症患者死亡率的可靠生物标志物对于优化重症监护室（ICU）的管理至关重要。炎症和代谢标志物的预后价值日益得到认可。本研究旨在评估各种炎症和代谢标记物与重症监护病房死亡率的关系：这项前瞻性观察研究于 2023 年 1 月至 2024 年 1 月在市立医院重症监护室进行。共纳入 160 名重症患者。研究分析了实验室指标，包括白细胞（WBC）计数、红细胞分布宽度（RDW）、血小板计数、中性粒细胞计数、平均血小板体积（MPV）、单核细胞计数、淋巴细胞计数、降钙素原（PCT）、C反应蛋白（CRP）、钙（Ca++）和维生素 D 水平。此外，还计算了血小板与淋巴细胞比率（PLR）、中性粒细胞与淋巴细胞比率（NLR）、全身炎症指数（SII）和泛免疫炎症值（PIV）等比率。用酶联免疫吸附法测定了血浆中富含Gla蛋白（GRP）和去磷酸化非羧基Gla蛋白（dp-ucMGP）的水平：研究对象的平均年龄为（60.5 ± 15.8）岁。72名患者（45%）患有心血管疾病，58名患者（36%）患有呼吸系统疾病，38名患者（24%）患有慢性肾脏疾病（CKD）。此外，61 名患者（38%）患有糖尿病，68 名患者（42%）患有高血压。非存活者的炎症指标，包括PLR、NLR和PIV都明显高于存活者，而钙和维生素D水平则低于存活者（P < 0.05）。WBC、RDW、中性粒细胞计数、PLR、NLR、PIV、CRP、降钙素原、GRP 和 dp-ucMGP 水平较高与住院时间延长和死亡率增加呈正相关。相比之下，血小板和淋巴细胞计数与这两种结果均呈负相关（P < 0.05）。维生素 D 水平与住院时间和死亡率均呈反比关系，表明维生素 D 水平越低，预后越差（P < 0.05）。在多重逻辑回归分析中，白细胞计数升高（OR = 1.20，p = 0.02）、RDW 升高（OR = 1.35，p = 0.01）、中性粒细胞计数升高（OR = 1.25，p = 0.01）、MPV 升高（OR = 1.20，p = 0.02）、PLR 升高（OR = 1.30，p = 0.01）、NLR 升高（OR = 1.40，p = 0.001）、PIV（OR = 1.50，p = 0.001）、CRP（OR = 1.32，p = 0.01）、降钙素原（OR = 1.45，p = 0.001）、GRP（OR = 1.40，p = 0.001）和 dp-ucMGP（OR = 1.30，p = 0.001）水平与死亡率增加显著相关：炎症和代谢标记物，尤其是 NLR、PLR、PIV、GRP 和 dp-ucMGP 是 ICU 患者死亡率的有力预测指标。这些标志物为风险分层和早期识别高危患者提供了宝贵的见解，有可能指导采取更有针对性的干预措施来改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Metabolites Biochemistry, Genetics and Molecular Biology-Molecular Biology

CiteScore

5.70

自引率

7.30%

发文量

1070

审稿时长

17.17 days

期刊介绍： Metabolites (ISSN 2218-1989) is an international, peer-reviewed open access journal of metabolism and metabolomics. Metabolites publishes original research articles and review articles in all molecular aspects of metabolism relevant to the fields of metabolomics, metabolic biochemistry, computational and systems biology, biotechnology and medicine, with a particular focus on the biological roles of metabolites and small molecule biomarkers. Metabolites encourages scientists to publish their experimental and theoretical results in as much detail as possible. Therefore, there is no restriction on article length. Sufficient experimental details must be provided to enable the results to be accurately reproduced. Electronic material representing additional figures, materials and methods explanation, or supporting results and evidence can be submitted with the main manuscript as supplementary material.