Serum alpha1-antitrypsin but not complement C3 and C4 predicts chronic inflammation in hemodialysis patients.
BACKGROUND
We studied whether predialysis serum levels of positive acute phase markers such as alpha1-antitrypsin (AT), and complement components C3 and C4 could identify the presence of chronic inflammation in maintenance hemodialysis (HD) patients.


RESULTS
In 103 stable HD patients, AT directly correlated with C-reactive protein (CRP) (P < 0.005), alpha1 acid-glycoprotein (P < 0.005), fibrinogen ( P < 0.05), lipoprotein (a) (P < 0.01) and von Willebrand factor antigen (P < 0.05), while C3 and C4 were not related to any of these inflammatory markers. In the patients with elevated CRP and hypoalbuminemia, the mean AT value of 1.74 +/- 0.50 g/L was higher (P = 0.008) than that of 1.38 +/- 0.27g/L in the subjects with normal CRP and albumin. Using the above cut-off levels, the positive and negative predictive values of AT on the presence of severe inflammation were 0.86 and 0.62, respectively, and the sensitivity and specificity were 86% and 73%, respectively.


CONCLUSIONS
Serum AT levels above 1.74 g/L and below 1.38 g/L may select the HD patients with severe inflammation from those without. Measurements of C3 and C4 are not helpful in this situation.
Borawski
Jacek
J
Department of Nephrology and Internal Medicine, Medical Academy, Białystok, Poland. jborawski@post.pl
Naumnik
Beata
B
Myśliwiec
Michał
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D003176:Complement C3 / Q000378:metabolism*; D003181:Complement C4 / Q000378:metabolism*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D009961:Orosomucoid / Q000378:metabolism; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism; D013223:Statistics as Topic; D016896:Treatment Outcome; D000515:alpha 1-Antitrypsin / Q000378:metabolism*; D014841:von Willebrand Factor / Q000378:metabolism
D015415:Biomarkers; D003176:Complement C3; D003181:Complement C4; D017270:Lipoprotein(a); D009961:Orosomucoid; D012709:Serum Albumin; D000515:alpha 1-Antitrypsin; D014841:von Willebrand Factor; D005340:Fibrinogen; D002097:C-Reactive Protein