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Publications by Year: 2014

2014

Moskowitz, Ari, Amanda Graver, Tyler Giberson, Katherine Berg, Xiaowen Liu, Amy Uber, Shiva Gautam, and Michael W Donnino. (2014) 2014. “The Relationship Between Lactate and Thiamine Levels in Patients With Diabetic Ketoacidosis.”. Journal of Critical Care 29 (1): 182.e5-8. https://doi.org/10.1016/j.jcrc.2013.06.008.
Publisher's Version

PURPOSE: Thiamine functions as an important cofactor in aerobic metabolism and thiamine deficiency can contribute to lactic acidosis. Although increased rates of thiamine deficiency have been described in diabetic outpatients, this phenomenon has not been studied in relation to diabetic ketoacidosis (DKA). In the present study, we hypothesize that thiamine deficiency is associated with elevated lactate in patients with DKA.

MATERIALS AND METHODS: This was a prospective observational study of patients presenting to a tertiary care center with DKA. Patient demographics, laboratory results, and outcomes were recorded. A one-time blood draw was performed and analyzed for plasma thiamine levels.

RESULTS: Thirty-two patients were enrolled. Eight patients (25%) were thiamine deficient, with levels lower than 9 nmol/L. A negative correlation between lactic acid and plasma thiamine levels was found (r = -0.56, P = .002). This relationship remained significant after adjustment for APACHE II scores (P = .009). Thiamine levels were directly related to admission serum bicarbonate (r = 0.44, P = .019), and patients with thiamine deficiency maintained lower bicarbonate levels over the first 24 hours (slopes parallel with a difference of 4.083, P = .002).

CONCLUSIONS: Patients with DKA had a high prevalence of thiamine deficiency. Thiamine levels were inversely related to lactate levels among patients with DKA. A study of thiamine supplementation in DKA is warranted.

Liu, Xiaowen, Ole-Petter R Hamnvik, John P Chamberland, Michael Petrou, Huizhi Gong, Costas A Christophi, David C Christiani, Stefanos N Kales, and Christos S Mantzoros. (2014) 2014. “Circulating Alanine Transaminase (ALT) and γ-Glutamyl Transferase (GGT), But Not Fetuin-A, Are Associated With Metabolic Risk Factors, at Baseline and at Two-Year Follow-Up: The Prospective Cyprus Metabolism Study.”. Metabolism: Clinical and Experimental 63 (6): 773-82. https://doi.org/10.1016/j.metabol.2014.03.008.
Publisher's Version

OBJECTIVE: To comparatively evaluate traditional liver tests and fetuin A as predictors of cardiometabolic risk, we studied associations between serum alanine transaminase (ALT), γ-glutamyl transferase (GGT), aspartate aminotransferase (AST) and fetuin-A and anthropometric, metabolic, and cardiovascular parameters cross-sectionally at baseline, and prospectively, after 2-years of follow-up.

RESEARCH DESIGN AND METHODS: 616 randomly enrolled young healthy participants in the Cyprus Metabolism Study, including all 93 subjects who participated in the follow-up study 2 years after baseline assessment, were included in this study.

RESULTS: In the cross-sectional study, serum ALT and GGT were strongly correlated with anthropometric, cardiovascular, and metabolic variables, while serum AST was only correlated with waist circumference and waist-to-hip ratio. Fetuin-A was correlated with anthropometric variables, systolic blood pressure (SBP), insulin, and homeostasis model of assessment-insulin resistance (HOMA-IR) in the unadjusted model. In the fully adjusted model, both serum ALT and GGT levels remained positively correlated with total and low-density lipoprotein (LDL) cholesterol. GGT levels also remained correlated with triglycerides. ALT levels remained strongly positively correlated with insulin (r=0.17, p<.0001) and HOMA-IR (r=0.16, p=0.0001). Serum fetuin-A levels were no longer significantly correlated with any variables. Prospectively, ALT and GGT were predictors of anthropometric variables and LDL cholesterol, while baseline levels of AST and fetuin-A were not predictors of any variables at 2-year follow-up.

CONCLUSIONS: We confirmed associations of ALT and GGT levels but failed to demonstrate an independent association between fetuin-A and cardiometabolic risk factors in young healthy men. Traditional liver tests (LFTs) are thus better than fetuin-A predictors of metabolic risk factors cross-sectionally and prospectively in young healthy adults.