Avalição entre índices inflamatórios derivados do hemograma e níveis plasmáticos de trombomodulina versus função endotelial em subamostra de participantes do estudo longitudinal da saúde do adulto (ELSA-Brasil)

Abstract

Endothelial dysfunction, characterized by the inability of arteries to dilate properly, is associated with changes in inflammatory and hemostatic markers. Thrombomodulin (TM), a membrane glycoprotein, plays a crucial role in vascular homeostasis by binding to thrombin, thereby modulating fibrinolytic and hemostatic processes. This study investigated the relationship between TM, inflammatory markers derived from blood counts, and endothelial function in participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), Minas Gerais Investigation Center (CI-MG). Measurements of TM, calculation of inflammatory indices, and assessment of endothelial function were performed using peripheral arterial tonometry (PAT). The results revealed that higher levels of TM were observed in men, particularly those with lower educational attainment (elementary or high school education) and excessive alcohol consumption. TM showed a negative correlation with the glomerular filtration rate (GFR), suggesting that renal dysfunction is associated with higher levels of this glycoprotein. Additionally, a positive correlation was found between TM and baseline pulse amplitude (BPA), indicating a tendency toward moderate endothelial dysfunction in individuals with elevated TM levels. Multiple logistic regression analysis showed that men were four times more likely to have higher TM levels, consistent with worse endothelial function. Regarding inflammatory markers, participants with better endothelial function exhibited lower red blood cell counts and higher platelet-to-lymphocyte ratios (PLR). Individuals with endothelial dysfunction displayed higher mean values for red blood cells, hemoglobin, mean corpuscular hemoglobin concentration (MCHC), hematocrit, and leukocytes, while platelets and PLR were lower. Among participants without chronic diseases, the 95% confidence intervals (CI) for the mean differences of these variables were wider (except for leukocytes, platelets, and PLR), suggesting that these parameters may be better markers of endothelial dysfunction in this group. On the other hand, participants without comorbidities in this group showed increased values for red blood cells, hemoglobin, and hematocrit, and the constructed ROC curves indicated that these parameters were not effective as markers of endothelial dysfunction in these individuals. In conclusion, men are more likely to have elevated TM levels, which are associated with worse endothelial function. Increased red blood cell counts were also linked to endothelial dysfunction. However, inflammatory indices derived from blood counts were not significantly associated with endothelial dysfunction in the studied sample, indicating their limitations as subclinical markers of this condition.