Background Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
Methods High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
Results The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
Conclusions The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.
Citations
Citations to this article as recorded by
Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease Armand N. Yazdani, Michaela Pletsch, Abraham Chorbajian, David Zitser, Vikrant Rai, Devendra K. Agrawal Expert Review of Cardiovascular Therapy.2023; 21(10): 675. CrossRef
Evaluation of Neopterin as a Neuroinflammatory Marker for Peripheral Neuropathy in Type 2 Diabetic Patients Israa Abdelmalik Salem, Sura Ahmed Abdulsattar, Haider Fadhil Alrubaye Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ).2023; 5(1S): S183. CrossRef
Background The renin-angiotensin-aldosterone system is closely associated with volume status and vascular tone in septic shock. The present study aimed to assess whether plasma renin activity (PRA) and plasma aldosterone concentration (PAC) measurements compared with conventional severity indicators are associated with mortality in patients with septic shock.
Methods We evaluated 105 patients who were admitted for septic shock. Plasma levels of the biomarkers PRA and PAC, the PAC/PRA ratio, C-reactive protein (CRP) level, and cortisol level on days 1, 3, and 7 were serially measured. During the intensive care unit stay, relevant clinical information and laboratory results were recorded.
Results Patients were divided into two groups according to 28-day mortality: survivors (n = 59) and non-survivors (n = 46). The survivor group showed lower PRA, PAC, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score than did the non-survivor group (all P < 0.05). The SOFA score was positively correlated with PRA (r = 0.373, P < 0.001) and PAC (r = 0.316, P = 0.001). According to receiver operating characteristic analysis, the areas under the curve of PRA and PAC to predict 28-day mortality were 0.69 (95% confidence interval [CI], 0.58 to 0.79; P = 0.001) and 0.67 (95% CI, 0.56 to 0.77; P = 0.003), respectively, similar to the APACHE II scores and SOFA scores. In particular, the group with PRA value ≥3.5 ng ml-1 h-1 on day 1 showed significantly greater mortality than did the group with PRA value <3.5 ng ml-1 h-1 (log-rank test, P < 0.001). According to multivariate analysis, SOFA score (hazard ratio, 1.11; 95% CI, 1.01 to 1.22), PRA value ≥3.5 ng ml-1 h-1 (hazard ratio, 3.25; 95% CI, 1.60 to 6.60), previous history of cancer (hazard ratio, 3.44; 95% CI, 1.72 to 6.90), and coronary arterial occlusive disease (hazard ratio, 2.99; 95% CI, 1.26 to 7.08) were predictors of 28-day mortality.
Conclusions Elevated PRA is a useful biomarker to stratify the risk of critically ill patients with septic shock and is a prognostic predictor of 28-day mortality.
Citations
Citations to this article as recorded by
Association of Active Renin Content With Mortality in Critically Ill Patients: A Post hoc Analysis of the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) Trial* Laurence W. Busse, Christopher L. Schaich, Mark C. Chappell, Michael T. McCurdy, Erin M. Staples, Caitlin C. Ten Lohuis, Jeremiah S. Hinson, Jonathan E. Sevransky, Richard E. Rothman, David W. Wright, Greg S. Martin, Ashish K. Khanna Critical Care Medicine.2024; 52(3): 441. CrossRef
Renin as a Prognostic Marker in Intensive Care and Perioperative Settings: A Scoping Review Yuki Kotani, Alessandro Belletti, Giacomo Maiucci, Martina Lodovici, Stefano Fresilli, Giovanni Landoni, Rinaldo Bellomo, Alexander Zarbock Anesthesia & Analgesia.2024; 138(5): 929. CrossRef
Renin as a Prognostic and Predictive Biomarker in Sepsis: More Questions Than Answers?* Emily J. See, James A. Russell, Rinaldo Bellomo, Patrick R. Lawler Critical Care Medicine.2024; 52(3): 509. CrossRef
Dysfunction of the renin-angiotensin-aldosterone system in human septic shock Christopher L. Schaich, Daniel E. Leisman, Marcia B. Goldberg, Micheal R. Filbin, Ashish K. Khanna, Mark C. Chappell Peptides.2024; 176: 171201. CrossRef
Blood urea nitrogen - independent marker of mortality in sepsis Martin Harazim, Kaiquan Tan, Marek Nalos, Martin Matejovic Biomedical Papers.2023; 167(1): 24. CrossRef
Critically ill children with septic shock: time to rediscover renin? Isabella Guzzo, Fabio Paglialonga Pediatric Nephrology.2023; 38(9): 2907. CrossRef
The role of proadrenomedullin, interleukin 6 and CD64 in the diagnosis and prognosis of septic shock Yasemin Bozkurt Turan BMC Anesthesiology.2023;[Epub] CrossRef
Renin Kinetics Are Superior to Lactate Kinetics for Predicting In-Hospital Mortality in Hypotensive Critically Ill Patients* Maniraj Jeyaraju, Michael T. McCurdy, Andrea R. Levine, Prasad Devarajan, Michael A. Mazzeffi, Kristin E. Mullins, Michaella Reif, David N. Yim, Christopher Parrino, Allison S. Lankford, Jonathan H. Chow Critical Care Medicine.2022; 50(1): 50. CrossRef
Mechanisms of Post-critical Illness Cardiovascular Disease Andrew Owen, Jaimin M. Patel, Dhruv Parekh, Mansoor N. Bangash Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Renin as a Marker of Tissue Perfusion, Septic Shock and Mortality in Septic Patients: A Prospective Observational Study Patrycja Leśnik, Lidia Łysenko, Małgorzata Krzystek-Korpacka, Ewa Woźnica-Niesobska, Magdalena Mierzchała-Pasierb, Jarosław Janc International Journal of Molecular Sciences.2022; 23(16): 9133. CrossRef
Angiotensin II and Vasopressin for Vasodilatory Shock: A Critical Appraisal of Catecholamine-Sparing Strategies Mojdeh S. Heavner, Michael T. McCurdy, Michael A. Mazzeffi, Samuel M. Galvagno, Kenichi A. Tanaka, Jonathan H. Chow Journal of Intensive Care Medicine.2021; 36(6): 635. CrossRef
Treatment of Renin-Angiotensin-Aldosterone System Dysfunction With Angiotensin II in High-Renin Septic Shock Jonathan H. Chow, Marianne Wallis, Allison S. Lankford, Zackary Chancer, Rolf N. Barth, Joseph R. Scalea, John C. LaMattina, Michael A. Mazzeffi, Michael T. McCurdy Seminars in Cardiothoracic and Vascular Anesthesia.2021; 25(1): 67. CrossRef
Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-art and expert consensus Andrea CARSETTI, Elena BIGNAMI, Andrea CORTEGIANI, Katia DONADELLO, Abele DONATI, Giuseppe FOTI, Giacomo GRASSELLI, Stefano ROMAGNOLI, Massimo ANTONELLI, Elvio DE BLASIO, Francesco FORFORI, Fabio GUARRACINO, Sabino SCOLLETTA, Luigi TRITAPEPE, Luigia SCUDE Minerva Anestesiologica.2021;[Epub] CrossRef
Use of Angiotensin II in Severe Vasoplegia After Left Pneumonectomy Requiring Cardiopulmonary Bypass: A Renin Response Analysis Brian Trethowan, Christopher J. Michaud, Sarah Fifer Critical Care Medicine.2020; 48(10): e912. CrossRef
Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients* Patrick J. Gleeson, Ilaria Alice Crippa, Wasineenart Mongkolpun, Federica Zama Cavicchi, Tess Van Meerhaeghe, Serge Brimioulle, Fabio Silvio Taccone, Jean-Louis Vincent, Jacques Creteur Critical Care Medicine.2019; 47(2): 152. CrossRef
Background Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS.
Methods We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching.
Results A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001).
Conclusions ACE inhibitor or ARB may have beneficial effect on ARDS patients.
Citations
Citations to this article as recorded by
Systematic review and meta-analysis of the clinical outcomes of ACEI/ARB in East-Asian patients with COVID-19 Nancy Xurui Huang, Qi Yuan, Fang Fang, Bryan P. Yan, John E. Sanderson, Masaki Mogi PLOS ONE.2023; 18(1): e0280280. CrossRef
Renin-angiotensin system modulators in COVID-19 patients with hypertension: friend or foe? Shakhi Shylesh C.M, Arya V S, Kanthlal S. K., Uma Devi P. Clinical and Experimental Hypertension.2022; 44(1): 1. CrossRef
A propensity score‐matching analysis of angiotensin‐converting enzyme inhibitor and angiotensin receptor blocker exposure on in‐hospital mortality in patients with acute respiratory failure Yi‐Peng Fang, Xin Zhang Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2022; 42(5): 387. CrossRef
The Renin-Angiotensin System as a Component of Biotrauma in Acute Respiratory Distress Syndrome Katharina Krenn, Verena Tretter, Felix Kraft, Roman Ullrich Frontiers in Physiology.2022;[Epub] CrossRef
ACE2-like enzyme B38-CAP suppresses abdominal sepsis and severe acute lung injury Takafumi Minato, Tomokazu Yamaguchi, Midori Hoshizaki, Satoru Nirasawa, Jianbo An, Saori Takahashi, Josef M. Penninger, Yumiko Imai, Keiji Kuba, Yu Ru Kou PLOS ONE.2022; 17(7): e0270920. CrossRef
Tidal Volume–Dependent Activation of the Renin-Angiotensin System in Experimental Ventilator-Induced Lung Injury* Xinjun Mao, Katharina Krenn, Thomas Tripp, Verena Tretter, Roman Reindl-Schwaighofer, Felix Kraft, Bruno K. Podesser, Yi Zhu, Marko Poglitsch, Oliver Domenig, Dietmar Abraham, Roman Ullrich Critical Care Medicine.2022; 50(9): e696. CrossRef
The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study Zhishen Ruan, Dan Li, Yuanlong Hu, Zhanjun Qiu, Xianhai Chen International Journal of Chronic Obstructive Pulmonary Disease.2022; Volume 17: 2001. CrossRef
Renin-angiotensin system at the interface of COVID-19 infection Rukhsana Gul, Uh-Hyun Kim, Assim A. Alfadda European Journal of Pharmacology.2021; 890: 173656. CrossRef
A pharmacological framework for integrating treating the host, drug repurposing and the damage response framework in COVID‐19 Jennifer H. Martin, Richard Head British Journal of Clinical Pharmacology.2021; 87(3): 875. CrossRef
A comprehensive guide to the pharmacologic regulation of angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 entry receptor Murat Oz, Dietrich Ernst Lorke, Nadine Kabbani Pharmacology & Therapeutics.2021; 221: 107750. CrossRef
Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis Hyun Woo Lee, Chang-Hwan Yoon, Eun Jin Jang, Chang-Hoon Lee Thorax.2021; 76(5): 479. CrossRef
Evaluation of expression of VDR-associated lncRNAs in COVID-19 patients Mohammad Taheri, Lina Moallemi Rad, Bashdar Mahmud Hussen, Fwad Nicknafs, Arezou Sayad, Soudeh Ghafouri-Fard BMC Infectious Diseases.2021;[Epub] CrossRef
Mechanisms of Damage to the Cardiovascular System in COVID-19 Alexandr Y. Fisun, Yuriy V. Lobzin, Dmitry V. Cherkashin, Vadim V. Tyrenko, Konstantin N. Tkachenko, Vasilii A. Kachnov, Gennadiy G. Kutelev, Ignat V. Rudchenko, Alexey D. Sobolev Annals of the Russian academy of medical sciences.2021; 76(3): 287. CrossRef
Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers Chirag Bavishi, Thomas M. Maddox, Franz H. Messerli JAMA Cardiology.2020; 5(7): 745. CrossRef
COVID-19, ACE2, and the cardiovascular consequences Andrew M. South, Debra I. Diz, Mark C. Chappell American Journal of Physiology-Heart and Circulatory Physiology.2020; 318(5): H1084. CrossRef
Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review Nicholas E. Ingraham, Abdo G. Barakat, Ronald Reilkoff, Tamara Bezdicek, Timothy Schacker, Jeffrey G. Chipman, Christopher J. Tignanelli, Michael A. Puskarich European Respiratory Journal.2020; 56(1): 2000912. CrossRef
Putative contributions of circadian clock and sleep in the context of SARS-CoV-2 infection Miguel Meira e Cruz, Masaaki Miyazawa, David Gozal European Respiratory Journal.2020; 55(6): 2001023. CrossRef
COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis? Massimo Imazio, Karin Klingel, Ingrid Kindermann, Antonio Brucato, Francesco Giuseppe De Rosa, Yehuda Adler, Gaetano Maria De Ferrari Heart.2020; 106(15): 1127. CrossRef
Vitamin D receptor stimulation to reduce acute respiratory distress syndrome (ARDS) in patients with coronavirus SARS-CoV-2 infections Jose Manuel Quesada-Gomez, Marta Entrenas-Castillo, Roger Bouillon The Journal of Steroid Biochemistry and Molecular Biology.2020; 202: 105719. CrossRef
Bloqueantes del sistema renina-angiotensina e infección por COVID-19 L.M. Ruilope, J.A. Garcia Donaire, A. de la Sierra Hipertensión y Riesgo Vascular.2020; 37(3): 99. CrossRef
COVID-19: The Influence of ACE Genotype and ACE-I and ARBs on the Course of SARS-CoV-2 Infection in Elderly Patients
Jerzy Sieńko, Maciej Kotowski, Anna Bogacz, Kacper Lechowicz, Sylwester Drożdżal, Jakub Rosik, Marek Sietnicki, Magdalena Sieńko, Katarzyna Kotfis Clinical Interventions in Aging.2020; Volume 15: 1231. CrossRef
A dissection of SARS‑CoV2 with clinical implications (Review) Felician Stancioiu, Georgios Papadakis, Stelios Kteniadakis, Boris Izotov, Michael Coleman, Demetrios Spandidos, Aristidis Tsatsakis International Journal of Molecular Medicine.2020; 46(2): 489. CrossRef
Outcomes Associated with the Use of Renin-Angiotensin-Aldosterone System Blockade in Hospitalized Patients with SARS-CoV-2 Infection Imran Chaudhri, Farrukh M. Koraishy, Olena Bolotova, Jeanwoo Yoo, Luis A. Marcos, Erin Taub, Haseena Sahib, Michelle Bloom, Sahar Ahmad, Hal Skopicki, Sandeep K. Mallipattu Kidney360.2020; 1(8): 801. CrossRef
Coronavirus Disease 2019 and Hypertension: The Role of Angiotensin-Converting Enzyme 2 and the Renin-Angiotensin System Daniel L. Edmonston, Andrew M. South, Matthew A. Sparks, Jordana B. Cohen Advances in Chronic Kidney Disease.2020; 27(5): 404. CrossRef
Disequilibrium between the classic renin-angiotensin system and its opposing arm in SARS-CoV-2-related lung injury Riccardo Sarzani, Federico Giulietti, Chiara Di Pentima, Piero Giordano, Francesco Spannella American Journal of Physiology-Lung Cellular and Molecular Physiology.2020; 319(2): L325. CrossRef
COVID-19 and renin-angiotensin system modulators: what do we know so far? Angel de la Cruz, Shoaib Ashraf, Timothy J. Vittorio, Jonathan N. Bella Expert Review of Cardiovascular Therapy.2020; 18(11): 743. CrossRef
Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis Syed Shahzad Hasan, Chia Siang Kow, Muhammad Abdul Hadi, Syed Tabish Razi Zaidi, Hamid A. Merchant American Journal of Cardiovascular Drugs.2020; 20(6): 571. CrossRef
Renin-Angiotensin System Inhibitors in COVID-19: Current Concepts Kunal Mahajan, Prakash Chand Negi, Neeraj Ganju, Sachin Sondhi, Naresh Gaur, Rao Somendra, Tomohiro Katsuya International Journal of Hypertension.2020; 2020: 1. CrossRef
Role of Renin-Angiotensin System in Acute Lung Injury Caused by Viral Infection
Yan-Lei Gao, Yue Du, Chao Zhang, Cheng Cheng, Hai-Yan Yang, Yue-Fei Jin, Guang-Cai Duan, Shuai-Yin Chen Infection and Drug Resistance.2020; Volume 13: 3715. CrossRef
Are losartan and imatinib effective against SARS-CoV2 pathogenesis? A pathophysiologic-based in silico study Reza Nejat, Ahmad Shahir Sadr In Silico Pharmacology.2020;[Epub] CrossRef
Renin–Angiotensin System: An Important Player in the Pathogenesis of Acute Respiratory Distress Syndrome Jaroslav Hrenak, Fedor Simko International Journal of Molecular Sciences.2020; 21(21): 8038. CrossRef